الفهرس 
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Abstract
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). According to recent reports, the incidence of HCC has increased sharply in the last 5–10 years, with an especially high incidence in Egypt (Anwar et al., 2008).
The main goal of our study was to evaluate the role of AAG in the diagnosis of HCC in combination with alpha-fetoprotein which is the most widely used tumor marker for diagnosis as well as surveillance of HCC.
The study was performed on 40 patients recruited from the Internal Medicine & Hepatology Department, Ain Shams University Hospitals. Patients were classified into 2 groups; Group I consisted of 20 HCC patients , their ages are ranged between 42 and 63 years (mean 55.7 ± 6 years) included 19 male patients (95%) and 1 female patients (0.5%), this group is subdivided into low AFP HCC(200ng/ml)and high AFP HCC(200ng/ml), Group II consisted of 20 chronic liver disease patients, their ages are ranged between 43 and 62 years (mean 53.3±4 years) included 17 male patients (85%) and 3 female patients (15%).
Patients in the two groups were subjected to full history taking, thorough clinical examination and laboratory investigations including alpha-fetoprotein and serum AAG together with abdominal ultrasonography and triphasic spiral computed tomography.
The clinical features of studied patients; hepatomegaly, splenomegaly, lower limp edema, Ascites, hepatic encephalo-pathy and jaundice were most common manifestation in most of both groups of patients.
As regards the liver function tests, they were worse in chronic liver disease and in HCC patients, in which no statistically differences in liver function tests between 2 groups of patients.
There is no significant correlation between AAG and AFP in both groups, versus clinical picture, laboratory data and child Pugh classification.
Our study revealed that serum AAG level is statistically highly significant in patients with HCC than those with chronic liver disease.
Serum AAG is not significantly correlated to AFP level or any laboratory parameter. Also, it is not significantly correlated to number or size of the focal lesion.
The absence of correlation between AAG and AFP suggests that each marker is related to a different aspect of HCC, therefore the use of both of them in combination could significantly improve the diagnostic accuracy for HCC. This seems particularly important for those patients with normal concentrations of AFP whose disease might otherwise not have been recognized as HCC (Gianelli et al., 2007).
In this study by using serum AAG in combination with AFP, a diagnostic model for HCC detection with high sensitivity and specificity has been generated. AS in total HCC patients , sensitivity and specificity of the combination of AAG and AFP were (92%, 88%) respectively in comparison to (90%, 85%) respectively for AFP alone, while in low AFP HCC (less than 200ng/ml) the sensitivity and specificity of the combination of AAG and AFP were (95%, 85%) respectively, in comparison to (88%, 75%) respectively, to AFP alone.