Pengfei Ren,1,2,* Keyan Wang,3,* Jie Ma,1,2 Xiaoqin Cao,4 Jiuzhou Zhao,1,2 Chengzhi Zhao,1,2 Yongjun Guo,1,2 Hua Ye5,6 1Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Peopleâs Republic of China; 2Henan Key Laboratory of Molecular Pathology, Zhengzhou, Peopleâs Republic of China; 3Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Peopleâs Republic of China; 4Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Peopleâs Republic of China; 5College of Public Health, Zhengzhou University, Zhengzhou, Peopleâs Republic of China; 6Henan Key Laboratory of Tumor Epidemiology and State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Peopleâs Republic of China*These authors contributed equally to this workCorrespondence: Yongjun Guo, Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou, 450008, Peopleâs Republic of China, Fax +86 371 65587506 Email guoyongjun@zzu.edu.cn Hua Ye, College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Peopleâs Republic of China, Fax +86 371 67781248, Email yehua@zzu.edu.cnPurpose: Ferritin is a protein that plays an important role in iron metabolism, it consists of two subunits: heavy chain (FTH) and light chain (FTL). Elevated expression of FTL is observed in multiple malignancies. Recent studies have found that the frequency of circulating autoantibody against FTL (anti-FTL) increased significantly in hepatocellular carcinoma (HCC). The aim of this study is to verify circulating anti-FTL as a biomarker for the early detection of HCC.Patients and Methods: A total of 1565 participants were enrolled and assigned to two independent validation cohorts, including 393 HCC patients, 379 liver cirrhosis (LC) patients, 400 chronic hepatitis (CH) patients, and 393 healthy subjects. The concentration of serum anti-FTL was measured by indirect Enzyme-Linked Immunosorbent Assay (ELISA). KruskalâWallis test was used to compare anti-FTL concentrations between HCC group and three control groups. Percentile 95 of anti-FTL absorbance value of healthy group was selected as the cut-off value to calculate the positive rate in each group. The area under receiver operating characteristic curve (AUC) was used to quantitatively describe its diagnostic value.Results: The median concentration of anti-FTL in HCC patients was higher than that in CH patients and healthy subjects, but there was no difference between HCC patients and LC patients. Further analysis showed that there was no difference between early stage LC, advanced stage LC, Child-Pugh A HCC, Child-Pugh B HCC and Child-Pugh C HCC. The positive rate of anti-FTL was 12.2% (48/393) in HCC, 13.5% (51/379) in LC, 6.3% (25/400) in CH and 5.1% (20/393) in healthy subjects, respectively. The AUC of anti-FTL to distinguish LC from CH or healthy subjects were 0.654 (95% CI: 0.615â 0.692) and 0.642 (95% CI: 0.602â 0.681), respectively.Conclusion: Anti-FTL is not a biomarker for the early diagnosis of HCC due to specificity deficiency, but may be helpful for the early detection of LC.Keywords: biomarker, ferritin light chain, hepatocellular carcinoma, liver cirrhosis, tumor-associated antigen