الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Summary
epatocellular carcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer death worldwide with about 600, 000 patients dying from the disease annually. It accounts for 85 % to 90 % of primary liver cancers. The most common risk factors of HCC are chronic hepatitis and liver cirrhosis caused by hepatitis B virus and hepatitis C virus infections.
Hepatocellular carcinoma is usually asymptomatic in the early stages and tends to be intravascularly and intrabiliary invasive. Therefore, most patients present with an incurable disease at the time of detection. These indicate the importance of monitoring the progression of hepatic disease for early diagnosis and follow progression of HCC which is critical for a good prognosis.
It has been widely reported that AFP, the only serological marker currently available in clinical practice, is not a sufficiently reliable marker to identify early HCC, mainly because it lacks organ and tumor specificity and has low sensitivity particularly in early stage disease. So that appearance of new markers for early accurate detection of HCC is strongly needed.
Angiogenin is a potent angiogenic factor belonging to the ribonuclease superfamily. Normal human tissue cells known to
H
Summary and Conclusion
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express angiogenin include vascular endothelial cells, fibroblasts and normal peripheral blood lymphocytes. Subsequently, it has been found to have a wide tissue distribution, with the liver to be the major source for circulating angiogenin in plasma. Many reports demonstrated elevated serum ANG levels in various malignancies, as colorectal carcinoma, melanoma, pancreatic carcinoma, ovarian carcinoma, urothelial carcinoma and nasopharyngeal carcinoma, thus pointing to the angiogenin as a novel indicator of tumor progression and aggressiveness.
In this regard, our study aimed to evaluate serum angiogenin level in Egyptian cirrhotic patients as well as in patients with HCC on top of cirrhosis, and to assess its clinical significance as a predictor factor for HCC.
This study was conducted on 70 patients attending the Internal Medicine Department of Ain Shams University Hospitals in addition to 15 matched apparently healthy control subjects. Patients were divided into two groups according to their diagnosis. Group I included 40 patients with liver cirrhosis. Group II included 30 HCC patients who were further divided into subgroups based on the stage of the disease, as determined by TNM classification system. All patients of group I and II were classified according to Child-Pugh Classification to A, B and C.
All patients in this study were subjected to full history taking and clinical examination, radiological investigations including abdominal U/S and triphasic spiral CT scan (for
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group II), routine laboratory investigations, hepatitis viral markers and serum AFP in addition to serum ANG assay by ELISA technique.
Serum AFP was significantly higher in HCC group when compared to liver cirrhosis group or control group, But this high level of serum AFP was found with no significant correlation with tumor size or HCC stage.
Our results showed that serum ANG was significantly higher in patients with liver cirrhosis when compared to control group. Regarding our correlation study in liver cirrhosis patients, these high ANG level showed significant positive correlation with platelet count, while it showed non significant correlation with patients age, sex, etiology of liver cirrhosis, Child-Pugh score, serum AFP or any of the liver function tests.
Moreover, serum ANG was significantly higher in HCC group when compared to liver cirrhosis group or control group. Furthermore, the results also showed a high significant positive correlation between serum ANG level and the number of primary HCC focal lesions, their total size and HCC stages.
Assessment of the diagnostic performance of serum ANG and AFP in discriminating HCC from liver cirrhosis; revealed that the best cutoff for ANG was 311ng/mL with a diagnostic sensitivity 86.7%, specificity 92.5%, PPV 90.2%, NPV 89.7%,diagnostic efficacy 95.2%. Regarding serum AFP, the best cutoff
Summary and Conclusion
178 was 38.6IU/mL with a diagnostic sensitivity 80%, specificity 100%, PPV 87%, NPV 100%, diagnostic efficacy 90.6%.In conclusion, the present work documented that serum ANG is a promising tumor marker that could be added to the current standard tests for early diagnosis of HCC in normal or cirrhotic patients, and its higher levels in late tumour stages and metastasis, indicating that it can serve as a independent predictor for its progression and metastasis, in order to detect the disease at an early stage and hence improving the prognosis and survival rate of the patient.