الفهرس 
HEPATOCELLULAR CARCINOMAOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is the fifth most common
tumour worldwide and the second most common cause of
cancer-related death with a male-to-female predominance
greater than 2:1.
The presence of cirrhosis represents a key risk factor for
the development of HCC. The prevalence of cirrhosis among
patients with HCC has been estimated to be 85%-95% and
the HCC incidence rate among patients with cirrhosis has
been shown to be 2%-4% per year.
HCC is an inflammation-related cancer, as a chronic
inflammatory state is necessary for cancer appearance. HCC
is a major cause of cancer-related death due to lack of early
detection methods, ineffective therapies and frequent
recurrence or metastasis. Late diagnosis leads to only a small
percentage of patients to be suitable for effective therapeutic
options as liver transplantation, resection or local ablation
therapy.
AREG expression in normal liver is very low; however,
its level is markedly increased upon liver injury, providing a
prominent regenerative role in liver tissues . However, it was found that AREG stimulates connective tissue growth
factor expression and extracellular matrix-producing cells
proliferation . This shows that excessively active reparative
response by AREG participates in liver fibrosis.
HCC cells were found to overexpress and secrete AREG
producing an autocrine stimulation loop to achieve selfsufficiency in growth signals.
Our study depended on assessment of the diagnostic
performance of serum AREG in HCC detection in addition to
their correlation with different clinicopathological parameters
in HCC and cirrhotic patients.
AREG have raised interest as a possible predictor of the
presence and progression of HCC.
The aim of this study is to evaluate the diagnostic value
of serum level AREG as a tumor marker for HCC and its
prognostic value after transarterial chemoembolization
(TACE) and radiofrequency ablation (RFA), in comparison
to alpha-feto protein (AFP).
The study included 60 subjects divided into two groups:
group I was 30 randomly patients with liver cirrhosis as a
control, group II was 30 patients with hepatocellular
carcinoma who underwent intervention with TACE or RF.All patients subjected to the following:
1. Full history taking.
2. Full clinical examination with special emphasis on the
presence of signs of chronic liver disease (spider naevi,
palmar erythema, level of consciousness, flapping
tremors, ascites, splenomegaly, jaundice) or signs of
hepatocellular carcinoma (cachexia, loss of weight,
refractrory ascites)
3. Routine laboratory investigations including: complete
blood count, serum creatinine and blood urea nitrogen,
serum alanine aminotransferase, serum aspartate
aminotransferase, serum alkaline phophatase, total and
direct bilirubin, serum albumin and total proteins,
prothrombin time for assessment of the child score.
4- Viral markers: Hepatitis C virus antibody, Hepatitis B
virus surface antigen (HBsAg)
5- Serum Alpha fetoprotein
6- Radiological study:
Abdominal ultrasonography to assess the presence of liver
cirrhosis, ascites and hepatic focal lesions Tri phasic spiral CT abdomen: CT is done in different
phases of contrast enhancement (early and late arterial
and portal venous phases) it will be done for any patient
showing a suspected focal lesion in the abdominal
ultrasound.
Dynamic MRI; if spiral CT is non conclusive.
7- Measurement of Serum AREG for all patients before
intervention.
8- Follow up of the patients who had HCC and undergone
either RFA or TACE will be done after six months by
measuring serum level of alfa feto protein and AREG and
triphasic spiral CT.
This study showed that:
Serum AREG levels was significantly higher between
HCC group and liver cirrhosis group and it is suitable for
diagnostic use.
AREG showed direct significant correlation with liver
enzymes (AST and ALT levels) and Child Pugh Score.
AREG levels in the HCC group were affected by
number of the tumor and overall size.It was shown that the follow up level of AREG had a
significant diagnostic performance in diagnosis of HCC
recurrence at cut off value of ≥ 29.7 with sensitivity of 60%
and specificity was 96%. However.
In conclusion, AREG is not suitable as a diagnostic
marker for HCC but can be used as a prognostic marker for
HCC after treatment, as it was found to be useful in
prediction of possible tumour recurrence.