الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor worldwide, and the third most common cause of cancer related deaths. In Egypt HCC is the second most common malignant tumor, most Egyptian patients presented in late stage in 85% of cases. HCC can only be cured if diagnosed at an early stage.
Up to 20% of HCC do not produce AFP, even when very large, and slight increases are usual in acute hepatitis, chronic hepatitis and cirrhosis and overlaps can cause diagnostic difficulties.
The aim of this study to determined value of serum GP73 in diagnosis of HCC in high risk patient (cirrhotic patient).
This study was conducted on 80 individuals who were divided into three groups: group A (HCC group) included 30 patients with HCC on the background of liver cirrhosis. HCC was diagnosed according to AASLD guidelines (Bruix and Sherman, 2005).
group B (chronic liver disease group) included 30 patients with cirrhotic liver disease without any evidence of hepatic focal lesions as excluded by ultrasonography and AFP estimation. Diagnosis of chronic liver disease was based on standard clinical, biochemical, ultrasonographic criteria
The third group included 20 normal subjects who served as the control group. All patients and controls signed an informed written consent after explanation of the aim of the study and the procedure.
We determined the level of AFP and GP73 for all cases together with full clinical assessment, liver biochemical profile, kidney function test, viral markers, conventional US and tri-phasic abdominal CT scan
Serum AFP was elevated in HCC group (Mean=368.78 ng/ml) when compared with both control (1.5 ng/ml) and chronic liver disease (43 ng/ml) groups.
GP73 level was also significantly elevated in the HCC group (Mean = 13.4 ng/ml) when compared with both the control (0.66 ng/ml) and chronic liver disease (1.9 ng/ml) groups.
Positive correlation was found in this study between serum GP73and serum AFP in HCC group (r = 0.765 ; p = 0.001).
It was also found that when using a cutoff level of AFP at 19.85 ng/ml (best cutoff level for the study) it had a sensitivity of 90 % and a specificity of 66.7 % The cutoff level of sGp73 for diagnosis of HCC in this study was 5.8 ng/ml, with a sensitivity of 95% and specificity of 83.3%. It was found that diagnostic efficacy index of AFP 0.76 and diagnostic efficacy index of GP73 is 0.93 .
The combined use of the two markers (AFP and GP73) lead to an increase in the sensitivity, specificity and diagnostic accuracy of AFP from 90%, 66.7% and 76.2%, respectively to 100%, 81% and 91%, respectively.