الفهرس 
HEPATOCELLULAR CARCINOMAOnly 14 pages are availabe for public view
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Abstract
H
CC represents approximately 90% of all primary liver cancer cases, shows a clear gender disparity towards males and is a major cancer in less developed regions, with a correlation to HBs Ag prevalence.
Chronic HBV and HCV infections represent the leading cause for HCC (60–70%), with a total incidence of 16/100 000 globally. In most of Africa and Asia, HBV is the single leading risk factor for HCC, whereas in Japan, northern Europe, Egypt and the USA HCV is the major risk factor.
Recently AFP model proposed as prognostic tool which was designed in a French training cohort of HCC candidates it has been shown to be more accurate than Milan criteria for selecting HCC candidates in this French population.
This study is A retrospective and prospective cohort study and was conducted at Tropical Medicine department and HCC clinic, Ain Shams University Hospitals it included All newly diagnosed patients with HCC who are fit for locoregional treatment (TACE, RFA) according to BCLC:
Retrospectively: from 4/2012 till 4/2017.
Prospectively: from 5/2017 till 12/2017.
The enrolled 200 patients had been followed up till death or till the end of the study (5/2018).
The AFP model was calculated for each patient enrolled in the study before intervention.
Patients were followed up by AFP, laboratory investigations and triphasic spiral CT performed 1 month after RFA or TACE to evaluate the response and then every 3 months to evaluate the recurrence.
The response criteria were defined using modified RECIST to assess hepatic or extra-hepatic tumor.
Then the patients were classified into two groups according to alpha feto protein model: Low risk group and high risk group in both RFA and TACE patients.
At the end of the study, the calculated model was used to assess:
1. The response to treatment in both RFA and TACE group in low and high risk groups.
2. Hcc recurrence in both RFA and TACE group in low and high risk groups.
3. Overall survival in both groups.
The mean age in both groups was around 58 years old. There was male predominance in HCC patients accounting for 63.2% in RFA group and 77.3% in TACE group with statistical significance P-value (0.035).
Most of the patients included in the study were HCV +ve where 88.2%of RFA and 89.4% 0f TACE were HCV+ve without reaching statistical significance.
In RFA group: patients with AFP model score less than or equal 2 (low risk group) had higher complete response rate (93.5%) than high risk group (81.8%).
And less recurrence rate (55.8%) in low risk group than in high risk group (63.2%).
Also, low risk group has a median recurrence free survival of 6.5 months.
In high risk group RFS was 6 months and 72.7 % died all without reaching statistical significance.
In low risk group TACE complete response was 91.23% of patients while in high risk group it was 73.3%, recurrence was lower 71.2% while in high risk it was 78.2%.
Also in low risk group 64.9 % died by the end of the study while in high risk 78.7%% died by the end of the study without reaching statistical significance.
In TACE group low risk patients had OS of 32 months and RFS of 10 months while high risk patients had OS of 29 months and RFS of 6 months with no statistical significance.
So in our study, in both TACE and RFA groups low risk patients according to AFP level had a better response, a longer survival and a less recurrence but without reaching statistical significance.