الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death worldwide. Hepatocellular carcinoma (HCC), which accounts for 70-85% of liver cancer cases, is always diagnosed in an advanced stage and is associated with a poor prognosis, with a 5-year overall survival rate of less than 15% Alpha-fetoprotein (AFP) is the most widely used serum marker for screening and initial diagnosis of HCC in clinical practice. However, the sensitivity of AFP is only about 60% at a cut-off value of 20 ng/mL, and the specificity is low. AFP levels remain normal in 15-30% of patients with advanced stage disease and increase in some patients with chronic hepatitis, liver cirrhosis, and other liver diseases Cross talk between cancer cells and their inflammatory microenvironment plays critical roles in the initiation and progression of cancer, including the promotion of angiogenesis, proliferation, and metastasis. Inflammatory infiltrates in the tumor microenvironment largely influence the biological behavior of HCC The ability to distinguish between HCC and liver disease using AFP and NLR together demonstrated more accuracy than using either marker alone. This work adds to our understanding of the clinical applications of the NLR because it is a readily quantifiable parameter on routine investigation. Patients and methods : This study conducted between May 2021 and August 2022 in Internal Medicine department, Gastrointestinal and Endoscopy Unit, Tanta University Hospitals. Study subjects: -The study was carried on 100 patients: • group A: 50 patients with newly diagnosed and treatment naive hepatocellular carcinoma. HCC was be diagnosed according to positive dynamic CT (hallmark of HCC during CT scan is the presence of arterial enhancement, followed by washout of the tumor in the portal-venous and/or delayed phases. • group B: 50 patients as a control group matched age and sex with chronic liver disease (patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and include samples from patients with hepatitis and cirrhosis due to viral and non viral causes. -Privacy of patients and confidentiality of data was assured through coding number. Study Design: Cross Sectional study. Inclusion criteria:Adult male or female. ➤ Has a diagnosis of hepatocellular carcinoma (only newly diagnosed and treatment naïve patients with HCC were enrolled in the study) ➤ Patients with chronic liver disease (mainly from patients infected with hepatitis B virus (HBV) or hepatitis C and patients with hepatitis and cirrhosis. Exclusion criteria: Subjects whom didn’t meet the inclusion criteria All patients in this study were subjected to the following: 6. Through history taking. 7. Complete clinical examination. 8. Ultrasound on the abdomen 9. Dynamic CT on the liver for patients with chronic liver disease 10. Laboratory investigations including: o Complete blood picture. o Numbers of neutrophils and lymphocytes were recorded from routine investigation. o The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. o Complete liver function tests. o Serum AFP was measured for all included patients using micro particle immunoassay. The main results of the study revealed that: Socio-demographic characteristics among the two studied groups showed that There was predominance of male sex in both groupS A & B (72% & 64% respectively) with no statistically significant difference between patients and control groups regarding sex (p>0.05). The mean age in group A & B was 55.58± 3.60 years and 53.02± 5.92 years respectively. There was no statistically significant difference between the two groups regarding age (p>0.05). in group A, 84% cases had cirrhosis and 16% cases had HCV. While in group B, 62% cases had cirrhosis, 28% cases had HCV and 10% cases had HBV. On comparison of Neutrophils, Lymphocytes, & NLR levels between patients and control groups, there was a highly statistically significant decrease in neutrophils level in HCC patients compared to controls (p<0.001). Also, there was a highly statistically significant decrease in lymphocytes level in HCC patients compared to controls (p<0.001). On the other hand there was a highly statistically significant increase in neutrophil-lymphocyte ratio in HCC patients compared to controls (p<0.001 ). On comparison of ALT, AST & AFP levels between patients and control groups, there was a highly statistically significant increase in ALT ,AST and AFP level in HCC patients compared to controls By using ROC-curve analysis, AFP alone can detect patients with hepatocellular carcinoma with sensitivity and specificity of 86% and 80 respectively when the cutoff point was 13 ng/mL. NLR can detect patients with hepatocellular carcinoma with sensitivity and specificity of 82% and 78% respectively when the cutoff point was >1.8. Also, combined AFP+NLR can detect patients with hepatocellular carcinoma with increasing the sensitivity and specificity into 92% and 88% respectively. By using ROC-curve analysis, AST individually can detect patients with hepatocellular carcinoma with sensitivity and specificity of 72% and 64% respectively when the cutoff point was 35 IU/mL while ALT individually can detect patients with hepatocellular carcinoma with sensitivity and specificity of 76% and 66% respectively when the cutoff point was 35 IU/mL on the other hand, combined AFP+AST can detect patients with hepatocellular carcinoma with increasing the sensitivity and specificity into 88% and 84% respectively while combined AFP+ALT can detect patients with hepatocellular carcinoma with increasing the sensitivity and specificity into 90% and 86% respectively.