Introduction:
Hepatocellular carcinoma (HCC) accounts for more than 90% of primary liver cancer, which is the fifth most common cancer and the leading cause of cancer-related death worldwide. Aim of the study was to investigate the clinical significance of YKL-40 in HCC patients with hepatitis B (HBV)-related cirrhosis.

Material and methods:
The present prospective observational study included 129 cases of HCC patients with HBV-related cirrhosis between January 2017 and April 2019. Also, 152 patients with only hepatitis B-related cirrhosis and 110 HCC patients with no cirrhosis were enrolled during the same period. Additionally, 100 healthy individuals were enrolled as a control group. Serum YKL-40 levels were determined using the enzyme linked immunosorbent assay (ELISA) method. Levels of serum albumin, total bilirubin, alanine aminotransferase (ALT) and aspartate transaminase (AST) as well as HCC-related biomarkers of α-fetoprotein (AFP), des-γ-carboxy prothrombin (DCP), γ-glutamyltransferase (GCT), α-L-fucosidase (AFU), carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were measured using automatic biochemical analyzers. Patients’ demographic and clinical characteristics were collected and analyzed.

Results:
The expression of YKL-40 was the highest in HCC patients with HBV-related cirrhosis and the lowest in the healthy controls, and the difference compared with other groups was significant. HCC patients showed markedly higher YKL-40 levels than the HBV-related cirrhosis patients. Patients with higher expression of YKL-40 showed higher rates of TNM stage IV, lymphatic metastasis and Child-Pugh C, as well as higher serum levels of AFP, AFU and CA19-9 than those in the patients with lower levels of YKL-40. YKL-40 level was positively correlated with AFP and AFU. Survival analysis showed that patients with higher expression of YKL-40 had a shorter 1-year survival time than the patients with lower YKL-40.

Conclusions:
YKL-40 was elevated in HCC patients with HBV-related cirrhosis and high expression of YKL-40 predicted poor prognosis and shorter 1-year survival.