الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is considered the 6th common cancer all over
the world and it is accounting for 75% to 85% of primary liver cancers. HCC is in the
fourth place as a cause of cancer death. AFP is the most commonly used biomarker for
detecting and monitoring HCC. However, the sensitivity and specificity of AFP are not
satisfactory.
Cell free DNA is short fragment of double-stranded DNA that can be detected in
both healthy individuals and patients with diseases. It is related to apoptosis and necrosis
of cancer cells. Also, inflammation influences the total plasma level of cfDNA.
This work aimed to evaluate the clinical significance of cfDNA as a diagnostic
biomarker in HCC comparing with AFP.
This study included 90 subjects that were divided into 3 groups: Control group
(which included 30 apparently healthy subjects), benign group (which included 30
patients diagnosed as benign liver diseases) and HCC group (which included 30 patients
diagnosed as HCC).
All participants were submitted to the followings: full history taking and
clinical examinations for disease diagnosis. Also, routine laboratory investigations
including: liver function tests, CBC, AFP and detection of cfDNA concentration &
integrity by real time PCR technique. Moreover, abdominal ultrasongraphy for tumor
size, triphasic CT abdomen & Child-Pugh classification for patients groups were done.
The results were tabulated and statistically analyzed. The results
revealed that:
All studied groups were matched regarding age and gender, as there were no
significant statistical differences among the studied groups (p = 0.181 and 0.955
respectively).
There were high significant statistical differences among studied groups regarding
ALT, AST, total bilirubin, albumin, HB, platelet count, prothrombin conc., INR and
AFP (P = 0.001).
Regarding AFP level ; There were high significant statistical differences in the
median level of AFP among the studied groups (p =0.001).
Regarding cfDNA integrity ; There were high significant statistical differences in
the median level of plasma cfDNA integrity among the studied groups (p= 0.001).
Regarding correlation between cfDNA Integrity and other studied variables in
HCC group; There was significant positive correlation between cfDNA integrity
and PT conc in HCC group (p = 0.049). Meanwhile, there was no statistical
significant correlation were found between cfDNA and other parameters
Receiver operating characteristic (ROC) graph; Revealed that the best cut off level
of cfDNA Integrity was ≤o.93 for discrimination between benign and HCC groups.
The sensitivity was 100%, the specificity 83%, positive predictive value 100%,
negative predictive value 86% and accuracy 92%.
Receiver operating characteristic (ROC) graph; Revealed that the best cut off level
of AFP was 49.3 for discrimination between benign and HCC groups. The
sensitivity was 97%, the specificity 100%, positive predictive value 98%, negative
predictive value 100% and accuracy 99%.
Receiver operating characteristic (ROC) graph for both cfDNA Integrity and AFP
for discrimination between benign and HCC groups; Revealed that the sensitivity
was 100%, the specificity 80%, positive predictive value 83%, negative predictive value 100% and accuracy 90%.