الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to evaluate the diagnostic and prognostic values of Alpha-L-fucosidase as a tumor marker of HCC
This study was conducted on 80 patients who were divided into two groups: Group I (HCC group) included 40 patients with HCC on the background of liver cirrhosis. HCC was diagnosed according to AASLD guidelines (Bruix and Sherman, 2005)
Group II (chronic liver disease group) included 40 patients with chronic liver disease without any evidence of hepatic focal lesions as excluded by ultrasonography and AFP estimation. Diagnosis of chronic liver disease was based on standard clinical, biochemical, ultrasonographic criteria and pathological data whenever feasible.
The third group included 40 normal subjects who served as the control group. All patients and controls signed an informed written consent after explanation of the aim of the study and the procedure.
We determined the level of AFP and AFU for all cases together with full clinical assessment, liver biochemical profile, viral markers, conventional US, triphasic abdominal CT scan and guided liver biopsy for HCC cases with atypical CT vascular pattern.
Serum AFP was significantly elevated in HCC group (Median = 31.67 ng/ml) when compared with both control (2.03 ng/ml)and chronic liver disease (11 ng/ml) groups.
AFU level was also significantly elevated in the HCC group (Median = 9.28 μmol/L/min) when compared with both the control (0.42 μmol/L/min) and chronic liver disease (0.9 μmol/L/min) groups. A negative correlation was found in this study between serum AFU and serum AFP in HCC group (r = -0.314 ; p = 0.049). So this statistical significant difference implies the diagnostic role of AFU in detection of HCC in cirrhotic patients.
It was also found that when using a cutoff level of AFP at 15.25 ng/ml (best cutoff level for the study) it had a sensitivity of 70 % and a specificity of 85 % . When considering a cutoff level at 200 ng/ml, the sensitivity fell to 25 % and the specificity rose to 100%. The cutoff level of AFU for diagnosis of HCC in this study was 2.3005 μmol/L/min, with a sensitivity of 90% and specificity of 97.5%.
For patients in the HCC group, the levels of AFU activity before any intervention (were = 9.28 μmol/L/min) and one-month after the intervention (were=2.64 μmol/L/min). This was of statisitical significant difference (P= 0.001). This proves the prognostic role of AFU and that it can be used as a prognostic factor to follow-up the efficacy of intervention for treatment of HCC.
The combined use of the two markers (AFP and AFU) led to an increase in the sensitivity, specificity and diagnostic accuracy of AFP from 70%, 85% and 79.7%, respectively to 95%, 100% and 99.1%, respectively.