الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality: HCC is the seventh most common cancer worldwide, and the third leading cause of cancer-related deaths (Ferlay et al., 2010).
Hepatocellular carcinoma (HCC) is one of the commonest cancers worldwide. It is a major health problem and its incidence is increasing. The presence of cirrhosis of the liver is the major risk factor and worldwide this is largely due to chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. The diagnostic modalities, especially with respect to hepatic imaging, have improved in recent years. This, along with HCC surveillance in patients with cirrhosis, has led to the detection of HCC at an earlier stage, when curative therapy is likely to be more successful. The major diagnostic techniques for HCC include serum markers, various imaging modalities and histological analysis (Gomaa et al., 2009).
Des-gamma-carboxyprothrombin (DCP) or prothrombin induced by vitamin K absence (PIVKA) is an abnormal prothrombin derived by an acquired defect in the post-translational carboxylation of the prothrombin precursor in HCC cells. DCP derived by reduction ccarboxylase activity that resulted in a lack of c-carboxylation of the glutamic-acid residues. The reduced activity of c-carboxylase was attributed to defective gene expression in HCC patients (Grizzi et al., 2007).
The aim of this work is to evaluate significance of serum level of PIVKA-II as a tumour marker for HCC and its importance in early detection of HCC.
In this study, patients were divided into 4 groups (each of 10 patients) during the period from December 2009 to May 2011.Thirty two of them were males, eight were female, and their age ranged from forty-five to seventy-seven years old.
Group I&II (20 patients) include HCC patients with focal hepatic lesions where serum AFP level is diagnostic for HCC in group I and within normal range in group II. Group III &IV (20 patients) include CLD patients without focal hepatic lesion where serum AFP is elevated above normal range but did not reach the diagnostic level for HCC in group III and is within normal range in group IV. A serum AFP cut-off value of more than 100 ng/ml was considered diagnostic for HCC and serum PIVKA-II cut-off value of more than 2 ng/ml was considered diagnostic for HCC.
In this study the prevalence of HCC is found in older people than younger which is related to the long period of exposure to the viral infection and carcinogenics.
It was found that PIVKA-II showed statistically significant high levels in HCC patients compared to CLD patients but no correlation existed between serum AFP and PIVKA-II levels as markers of HCC indicating that both are independent tumor markers.
In HCC patients, serum PIVKA-II significant positive correlation with PT and INR while did not show significant correlation with any of the liver functions test in CLD patients. AFP showed no significant correlation with any of Liver function tests in group I.
There was no relation between the two markers and child pugh classification.
Serum PIVKA-II shows significant positive correlation with each of tumor size and number of focal hepatic lesion while AFP did not shows significant correlation with these parameters.
PIVKA-II shows high ability to differentiate hepatic malignancy from cirrhosis as its high specificity and rare appearance in non malignant hepatic diseases.
No correlation was found between serum level of PIVKA-II and the etiology of CLD as HCV or HBV infection in both HCC and CLD patients.
It was found that PIVKA-II showed statistically significant high levels in HCC patients in with bad prognosis than in cases of good prognosis in group I&II.
Measurment of accuracy of PIVKA-II test showed that the sensitivity of PIVKA-II for detecting HCC was 75%, specificity was 85%, positive predictive value was 83.3%, negative predictive value was 77.2%, and over-all accuracy was 80%.When AFP and PIVKA-II are used together, the sensitivity increased.
PIVKA-II has showen a higher value in prediction and early detection of HCC in CLD patients compared to AFP. PIVKA-II showed low sensitivity despite high specificity for detecting HCC.
Combining PIVKA-II test together with AFP test gave better results confirming the complementary role between both markers.