الفهرس 
Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and it is one of the major causes of death, because of its high frequency and poor prognosis. Hepatocellular carcinoma is now a rather common malignancy in Egypt which usually develops on top of liver cirrhosis secondary to viral infection, as hepatitis C viruses increased the risk of HCC in the Egyptian patients.
Early diagnosis of HCC can improve the prognosis of HCC patients. Many research groups are evaluating the sensitivity of available tumor markers and also are investigating the development of novel markers. The primary marker for HCC is alpha fetoprotein (AFP), a single polypeptide chain glycoprotein. Generally, AFP shows acceptable sensitivity; however, AFP is not secreted in all cases of HCC and may be normal in as many as 40% of patients with early HCC (Nakatsura et al. 2003). In addition, the serum AFP level does not always correspond to the clinical stage of HCC (Nakagawa et al., 1999). Thus, AFP appears to have limited utility as a screening test (Bruix and Sherman, 2005) Vascular endothelial growth factor (VEGF) is a heparin-binding glycoprotein that is secreted from endothelial cells. Platelets release VEGF upon aggregation and may be a major source of VEGF delivery to tumors.Many tumors release cytokines that can stimulate the production of megakaryocytes in the marrow and elevate the platelet count. This can result in an indirect increase of VEGF delivery to tumors.
Serum vascular endothelial growth factor (VEGF) levels in HCC patients were significantly higher, compared to control individuals, and was correlated with venous invasion and advanced tumor stage. They concluded that the expression of VEGF in HCC tissues was correlated with AFP (Amaoka et al.,2007).
The aim of this study is to verify the possibility of using the plasma vascular endothelial growth factor level as a tumor marker for hepatocellular carcinoma and to evaluate its prognostic value in management of HCC
The study included 80 subjects divided into three groups: group I was 40 patients with hepatocellular carcinomas group II was 20 patients with HCV related liver cirrhosis and group III was 20 normal subjects serving as a control group.
All Subjects included in the study was subjected to the following:
1. Full history taking and complete physical examination.
2. Laboratory investigations:
Measurement of serum AFP and VEGF level
Using electrochemoluminescence and enzyme-linked immunosorbent assay respectively in the 3 groups of patients and were measured again after intervention in the HCC group
Liver function tests.
Renal function tests.
CBC.
Blood sugar.
3. Radiological investigations.
Abdominal ultrasonography.
Triphasic CT or magnetic resonance imaging. This study showed that:
The plasma VEGF level was significantly higher in group I patients (with HCC), than in the group II patients (cirrhosis) and control group.
VEGF showed direct significant correlation with the most of laboratory data specially liver enzymes (AST and ALT levels), serum bilirubin, INR and platelets.
This study showed that VEGF levels in the HCC group were affected by number of the tumor and overall size.
The sensitivity and specificity of VEGF for selective detection of the HCC group over cirrhotic group, was 97.5% and 95% respectively at a cut off value of 118.
The VEGF levels were significantly reduced in the HCC group of patients subjected to RF ablation and TACE
The sensitivity and specificity of AFP for selective detection of the HCC group over cirrhotic group, was 100% and 90% respectively at a cut off value of 8.14.
So plasma vascular endothelial growth factor serum level appears to be an additional diagnostic marker for HCC detection and also a prognostic marker in HCC management.