الفهرس 
Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is the most common primary liver cancer and its burden has been increasing in Egypt with a doubling in the incidence rate in the past 10 years. Up to 90% of HCC cases were attributed to HCV related cirrhosis .
Despite the availability of different treatment modalities, the general prognosis is still poor as most of the patients are diagnosed in a late stage. Therefore, there is a necessity for developing non-invasive reliable economic biomarker for early detection of HCC .
Alpha fetoprotein is the most widely used biomarker for HCC; unfortunately it has low sensitivity as it can be elevated in many other situations leading to an unreliable role of serum AFP in HCC surveillance .
MicroRNAs are small non-coding RNAs that function as endogenous silencers of numerous target genes .
MicroRNA192, a liver specific miRNA, is the most abundant miRNA expressed in hepatocytes. Unexpectedly, miRNA192 was also shown to be required for HCV replication. MiRNA192 is significantly upregulated in HCC and has multiple functions as tumor suppressor miRNA during hepatocarcinogenesis. It was suggested to be a promising target for HCC treatment as well as a diagnostic and prognostic marker for the progression of HCC .
A cross sectional observational study was performed on patients selected from outpatient clinics in Menoufia University hospital, Egypt, from October 2017 to October 2018. The study has been conducted on 100 participants and was divided into 3 groups:
group 1: Forty HCV+ve, cirrhotic patients with HCC (HCC group).
group 2: Forty HCV+ve, cirrhotic patients without HCC (Cirrhotic group).
Another twenty healthy subjects will be included as control group.
All participants were subjected to full medical history, complete clinical examination, and full basal laboratory and radiological investigations with collecting samples for serum miRNA 192 and serum AFP .
In the present study, there was no significant difference among studied groups regarding gender and age. Diabetes mellitus was found in 30% of HCC patients and in 20% of cirrhotic patients. About 60% of HCC patients were from rural areas and most of HCV patients were asymptomatic (77.5%).
In the current study about 67.5% of HCC group and 80 % of cirrhotic group are smoker. Most of HCC patients presented with fatigue (45%).
In the present study, ALT, AST and bilirubin were statistically significantly higher in HCC patients than in cirrhotic and in control group (P < 0.001). The platelets count and hemoglobin level were significantly lower in HCC group than in cirrhotic and control group (P < 0.001).
Summary
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In the current study the majority of our HCC patients were classified as Child B and C (62.5%, 32% respectively) and most cases in cirrhotic patients without HCC were Child A (95%).
In the present study, most cases of HCC group were staged terminal, intermediate and advanced representing 37.5%, 32.5%, 20% respectively according to BCLC scoring system.
In the present study, in HCC group the incidence of single lesion was more than multiple lesions; 65% and 32.5% respectively, and 77.8% of HCC cases have focal lesion size more than 3 cm.
The present study showed that AFP was significantly higher in HCC group than cirrhotic group and control group (P value = 0.006).
The current study revealed that miRNA192 level showed significant increase in HCC group than cirrhotic group and control group (P value =0.002 and 0.001 respectively). Specificity and sensitivity of miRNA192 for detection of HCC was 82.5% and 77.5% respectively.
In the current study, there was positive correlation between miRNA192 and AFP and bilirubin levels in HCC group. In cirrhotic group, there was positive correlation between miRNA192 and AFP, INR and MELD score.