Chen CZ, Li L, Qiu JF. Letter to the Editor: Serum chitinase-3-like protein 1 as a biomarker in liver disease: Concerns regarding postoperative recurrence and hepatitis-related confounding. World J Gastrointest Oncol 2026; 18(11): 124077 [DOI: 10.4251/wjgo.124077]
Corresponding Author of This Article
Chang-Zhi Chen, Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Guang Xi Medical University, No. 13 Dancun Road, Nanning 530031, Guangxi Zhuang Autonomous Region, China. chenchangzhi1@163.com
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Gastroenterology & Hepatology
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letter
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Chen CZ, Li L, Qiu JF. Letter to the Editor: Serum chitinase-3-like protein 1 as a biomarker in liver disease: Concerns regarding postoperative recurrence and hepatitis-related confounding. World J Gastrointest Oncol 2026; 18(11): 124077 [DOI: 10.4251/wjgo.124077]
World J Gastrointest Oncol. Nov 15, 2026; 18(11): 124077 Published online Nov 15, 2026. doi: 10.4251/wjgo.124077
Letter to the Editor: Serum chitinase-3-like protein 1 as a biomarker in liver disease: Concerns regarding postoperative recurrence and hepatitis-related confounding
Chang-Zhi Chen, Lin Li, Jing-Feng Qiu
Chang-Zhi Chen, Lin Li, Jing-Feng Qiu, Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Guang Xi Medical University, Nanning 530031, Guangxi Zhuang Autonomous Region, China
Author contributions: Chen CZ and Li L reviewed the literature and drafted the manuscript; Qiu JF conceived and supervised the work and critically revised the manuscript; all authors read and approved the final manuscript.
AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.
Conflict-of-interest statement: The author(s) report no conflicts of interest in this work.
Corresponding author: Chang-Zhi Chen, Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Guang Xi Medical University, No. 13 Dancun Road, Nanning 530031, Guangxi Zhuang Autonomous Region, China. chenchangzhi1@163.com
Received: June 5, 2026 Revised: July 21, 2026 Accepted: September 23, 2026 Published online: November 15, 2026 Processing time: 142 Days and 1.5 Hours
Abstract
With great interest, we read the article by Zhang et al entitled “Diagnostic value of serum chitinase-3-like protein 1 for liver fibrosis/cirrhosis and hepatocellular carcinoma” published in the World Journal of Gastrointestinal Oncology. This retrospective study evaluated the diagnostic and prognostic value of serum chitinase-3-like protein 1 (CHI3 L1) in liver fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and postoperative recurrence. We commend the authors for their important contribution in developing a novel serological biomarker for liver diseases. However, there are still several issues that need to be addressed in this study. The study suggests that serum CHI3 L1 can be used to monitor patients after hepatectomy and identify postoperative recurrence. However, it may be necessary to provide and compare serum CHI3 L1 data from HCC patients after curative resection (without recurrence) with the serological data from patients with postoperative recurrence, to better support this conclusion. In this study, patients with cirrhosis, HCC and postoperative recurrence were included. These populations are frequently accompanied by underlying hepatitis, which may affect serum CHI3 L1 levels and potentially confound the results. This overlap in disease etiologies and inflammatory activity might also help explain the relatively low diagnostic performance observed in the receiver operating characteristic analysis shown in Figure 1.
Core Tip: Serum chitinase-3-like protein 1 (CHI3L1) is a promising biomarker for liver fibrosis, cirrhosis, hepatocellular carcinoma, and postoperative recurrence. However, its value for recurrence surveillance would be better supported by comparing postoperative CHI3L1 levels between patients with and without recurrence after curative resection. In addition, underlying hepatitis and inflammatory activity may influence serum CHI3L1 levels and confound diagnostic performance. These factors should be considered when interpreting the clinical utility of CHI3L1 in liver disease.
