الفهرس 
Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) accounts for 70—80% of all primary liver tumors(Johnson, 2006). Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third leading cause of cancer-related mortality after lung and stomach cancers(Al Knawy et al., 2009).
Its incidence is increasing worldwide ranging between 3% and 9% annually(Velazquez et al., 2003).In Egypt, the annual proportion of HCC showed a significant rising trend from 4.0% in 1993 to 7.2% in 2002(El-Zayadi et al., 2005).
Like most cancers, HCC is also associated with haemostatic activation with a reported incidence of portal vein thrombosis (PVT) ranging from 20%-65%(Ikai et al., 2004).
Our study was held in Tropical Medicine Department, Ain Shams University Hospital in the period from December 2010 to October 2011.
The aim of our study was:
• to characterize the prevalence and risk factors for the development of PVT in patients with HCC.
• To determine the overall impact of PVT on survival in patients with HCC.
For better assessment, this study included number of (1121) cases. group 1; all HCC patients without PVT (902): formed of 622 cases from old records of HCC unit and 280 cases newly diagnosed.group 2; all HCC patients with PVT (219): formed of 164 cases from old records of HCC unit and 55 cases newly diagnosed.
All the studied cases were subjected to the following: careful medical history taking, full physical examination, and laboratory investigations including CBC, liver function tests, coagulation profile, serum creat., HBs Ag, HBc Ab, HCV Ab and AFP. Abdominal ultrasonography, triphasic CT scan and PV Dupplex were done. Child-Pugh score and MELD were calculated. Okuda and Barcelona staging were determined for new cases with portal vvein thrombosis.
Our results revealed that: the prevalence of PVT among HCC patients was 19.5%. which was not related to both age and sex. With median survival of two months. We had 23.6% of patients with PVT alive at the end of 10 months follow up duration.
The highest predictors for the presence of portal vein thrombosis are jaundice, (Splenomegly and Ascitis) in CT scan, AFP>100 and Child Class C as there was higher percentage of child C among PVT patients (26.9%) compared to 14.96% among HCC.
Splenomegaly, ascites and mean size of hepatic focal lesions were also associated with PVT.
Main cause of death among PVT patients was haematemesis (52.4%) followed by hepatic encephalopathy (35.7%).
Survival was closely related to Child class as higher survival among cases in child A (47.1%) compared to 14% in Child B and 10% in Child C.
Also was related to Okuda staging as higher percentage of survival among patients with Okuda 1.
Survival wasn’t related to AFP levels, MELD score or performance status. Also it wasn’t related to the morphological features of hepatic focal lesions like site, size and number.