الفهرس 
Anatomy of the liverOnly 14 pages are availabe for public view
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Abstract
Summary
Liver cancer is the fifth most common cancer and the third most
frequent cause of cancer-related death globally. Hepatocellular
carcinoma represents about 90% of primary liver cancers and
constitutes a major global health problem.
Approximately 90% of HCCs are associated with a known
underlying etiology, most frequently chronic viral hepatitis (B and C),
alcohol intake and aflatoxin exposure.
Chronic liver disease should be treated to avoid progression of liver
cirrhosis and hence HCC.
In patients with chronic hepatitis, antiviral therapies leading to
maintained HBV suppression in chronic hepatitis B and sustained viral
response in hepatitis C are recommended, since they have been shown
to prevent progression to cirrhosis and HCC development
Surveillance for HCC is recommended in all patients with cirrhosis
and has been associated with improved early detection and survival.
Although both radiologic tools and serologic markers exist for early
diagnosis of HCC, surveillance is currently primarily imaging-based.
Guidelines from the American Association for the Study of Liver
Diseases (AASLD) and European Association for the Study of the
Liver (EASL) recommend surveillance using ultrasound alone.
However, most HCC continue to be diagnosed beyond an early
stage due to underuse of HCC surveillance and insufficient sensitivity
of current surveillance tools. These data highlight the urgent need for
more accurate biomarkers to improve early HCC detection.Tumor biomarkers for accurate early detection are still lacking. The
data available shows that the biomarkers tested (i.e. AFP, AFP-L3 and
DCP) are suboptimal in terms of cost-effectiveness for routine
surveillance of early HCC.
GP73 is a resident Golgi specific membrane protein expressed by
biliary epithelial cells in normal liver, and its expression is increased
markedly in chronic liver diseases, especially in HCC cells and is a
promising biomarker for detection of HCC.
AFP is the most widely studied biomarker for HCC
prognostication and has been incorporated in several HCC staging
systems, including Cancer of Liver Italian Program (CLIP).
The study aimed at evaluation of serum Golgi protein 73(GP73) as
a diagnostic tumor marker and in the post treatment follow up of HCC
in hepatitis C cirrhotic patients treated by loco regional therapy and
comparing the results with alpha fetoprotein levels.
This prospective cohort study was performed on 80 subjects from
the outpatient clinics and inpatients of Tropical Medicine and
Infectious Diseases Department at Tanta University Hospitals and
divided into three groups;
group 1: included 30 hepatitis C cirrhotic patients with HCC before
and after loco regional therapy (microwave or/ RFA).
group 2: included 30 hepatitis C cirrhotic patients without HCC.
group 3: included 20 healthy individuals as a control group.
In this study, HCC commonly presented in males (23males) more
than females (7 females) with age ranging from 47 to 69 years, with a
male to female ratio 3:1.All patients were positive for HCV antibody &/or HCV RNA.
group I patients had HCC on top of cirrhotic liver as evidenced by
US & Triphasic C.T. scan.
GP73 level was measured in all patients in group I before
intervention and was followed 1 month, 3 months and 6 months after
loco regional therapy (RFA or/microwave ablation).
19 (63.33%) patients of group I underwent microwave ablation and
11 (36.67) patients underwent RFA.
26 patients of group I were well ablated following loco regional
therapy and no recurrence or de novo lesions appeared till six months
of follow up. De novo lesions appeared in 4 patients and required
second cession of ablation.
In this study AFP level was significantly higher in group I than
group II with a cut off value >20ng/ml and higher in group I than group
III, while no significant difference as regards AFP level was found
between group II&III.
AFP in group I was ranging between 4.53-384 ng/ml with mean
105.071ng/ml.
We found in this study that GP73 level was significantly higher in
group I than group II with a cut off value > 79.2ng/ml and higher in
group I than group III , while no significant difference as regards GP73
level was found between group II&III.
GP73 in group I was ranging between 79.2-570ng/ml with mean
214.283ng/ml.In this study, AFP level was significantly decreasing after ablation
than before it in well ablated lesions, also we found that GP73 level
was significantly lower in the follow up period after ablation than
before it in well ablated lesions while remained elevated in not well
ablated lesions, indicating the usefulness of GP73 both as a diagnostic
and prognostic biomarker in surveillance and follow up of HCC
respectively.
In group I; 86.67% of patients were well ablated and recurrence
occurred in 13.33% of patients and needed second intervention based
on Triphasic CT scan findings.
There was 4 AFP-negative HCC cases, in which the level of
GP73 was high before intervention and decreased after intervention in
the follow up periods
Meanwhile, GP73 level is significantly lower in the follow up periods
in group I after intervention than before it in well ablated lesions, also
remained elevated in recurrence, indicating its usefulness as a
prognostic marker.
Sensitivity to GP73 was 96.67 which is higher than that for AFP
86.67; meanwhile specificity to GP73 was 96 which is also higher than
that for AFP 84.