الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths world-wide with about 600,000 patients dying from the disease annually. HCC accounts for 85 % to 90 % of primary liver cancers. The most common risk factors of HCC are chronic hepatitis and liver cirrhosis caused by both hepatitis B and C viruses.
The diagnosis of HCC is mainly based on a combination of abdominal ultrasound and serum alpha fetoprotein (AFP) level. However, tumors that are too small will be missed by abdominal ultrasound and serum alpha fetoprotein level lacks tumor specificity and has low sensitivity particularly in early stage disease. Clearly, the available screening methods are inadequate for early detection and follow up of HCC so there is an urgent need for novel biomarkers to increase the sensitivity in early diagnosis of HCC.
The aim of this study was to verify the possibility of using the serum level of soluble CD25 as a potential biomarker for diagnosis and early detection of hepatocellular carcinoma.
This study was conducted at outpatient clinic in National liver Institute, Menoufiya University on 40 HCC patients (group I), 20 patients with liver cirrhosis (group II), in addition to 20 healthy control subjects (group III). Patients in group I were classified according to TNM staging into subgroup Ia which included (20) patients with stage I and stage II and subgroup Ib, which included (20) patients with stage III and stage IV.
All patients in this study were subjected to full history taking, thorough clinical examination, radiological investigations including abdominal U/S and CT scan, routine laboratory investigations and serum AFP in addition to serum sCD25 assay by ELISA technique.
Serum AFP showed no significant difference between liver cirrhosis group and control group. However, AFP was significantly higher in HCC group when compared to liver cirrhosis group or control group.
The present results showed that the serum sCD25 was significantly higher in patients with liver cirrhosis when compared to control group. Moreover, serum sCD25 was significantly higher in HCC group when compared to liver cirrhosis group or control group.
Correlation study within HCC patients revealed that sCD25 had very high significant correlations with tumor size, significant positive correlation with severity of liver disease.
No significant correlation was found between sCD25 and AFP (The correlation coefficient between serum CD25 and AFP values was not significant in different cases groups, indicating that measuring both markers in serum can improve the reciprocally holistic diagnostic value).
Our study identified the optimal sCD25 and AFP levels for potential prediction of development of HCC within healthy subjects. AFP best cut-off values were 5.3 ng/ml with a sensitivity of 92.5% and a specificity of 94.7%. The area under the curve was 0. 969 (95% CI =0.932-1.007, p<0.001). By comparison, sCD25 best cut-off values were 7.0 pg/mL, with a sensitivity of 90.0% and a specificity of 84.2%. The area under the curve was 0.904 (95% CI =0.817-0.991, p<0.001). At the level of 20 ng/ml, the recommended clinical cut-off value for AFP used in clinical practice, the sensitivity of AFP was 70.0% and the specificity was 100.0%. AFP was found to have a higher sensitivity and specificity than sCD25 in detecting the presence of HCC in healthy subjects.
In this study, we evaluated the performance of sCD25 in detecting early HCC by comparing the level of sCD25 in early HCC patients (TNM stages I and II) with the sCD25 responses of cirrhotic patients. In this ROC analysis, AFP best cut-off values were 9.85 ng/ml, with a sensitivity of 70.0% and a specificity of 85.0%. The area under the curve was 0.781 (95% CI= 0.636-0.927, p=0.002). By comparison, sCD25 best cut-off values were 7.15pg/ml, with a sensitivity of 90.0% and a specificity of 60.0%. The area under the curve was 0.717 (95% CI =0.554-0.881, p=0.019).
Soluble CD25 was found to have a higher sensitivity than AFP in detecting the presence of early HCC in cirrhotic patients.