الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is a major worldwide public health problem. It is well recognized that HCC detection at an early stage leads to better outcomes, with decreased mortality and increased 5-year survival.
Diagnosis of HCC depends mainly on radiological tools mainly triphasic CT abdomen. AFP is no longer the cornerstone in HCC diagnosis as it used to be. Recent studies reported its elevation in non-malignant conditions as well as non- hepatic malignancies.
Despite knowing the high-risk populations for HCC development, the lack of sensitive and specific biomarkers hinders early detection of the disease at a curable stage. Therefore, the identification of new diagnostic markers for HCC becomes a top priority.
The present study was designed to validate the role of serum miRNA-221 expression in diagnosis of HCC in Egyptian patients.
In order to achieve this goal, 20 HCC patients were included in the study. The diagnosis of HCC was based on ultrasonography and triphasic CT. The study also included 20 cirrhotic patients without evidence of HCC and 10 healthy subjects as controls.
All subjects were subjected to thorough history taking and clinical evaluation. Laboratory investigations were done for all subjects, including CBC and liver function profiles . Abdominal US was performed for all patients, while triphasic CT was performed to assess the characteristics of HCC. Hepatocellular carcinoma patients were classified into stage A, B, C and D using Barcelona Clinic Liver Cancer (BCLC) staging system.
Total RNA was extracted from serum samples followed by reverse transcription real time PCR. Expression of serum miRNA-221 was calculated using the comparative cycle threshold (CT) method (2–ΔΔCT).
Statistical analysis of the studied parameters showed that serum miRNA-221 levels in patients with HCC were significantly higher than in cirrhotic patients and control group.
The sensitivity and specificity of serum AFP and serum miRNA-221 expression levels as markers for the diagnosis of HCC have been determined by plotting a receiver-operating characteristic (ROC) curve.
At the cut-off value of >8, the sensitivity of serum AFP in detecting HCC has been estimated to be 60% while its specificity has been shown to be 65%.
MiRNA-221 has a sensitivity of 85% and a specificity of 55% at the cut-off value of 1.0317 for the diagnosis of HCC.
Serum miRNA-221 expression level is more sensitive biomarker in diagnosis of HCC than the traditional marker, AFP. Therefore, serum miRNA-221 can be used as a useful additional biomarker, with AFP for screening of HCC among patients with liver cirrhosis.