الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world (El-Serag, 2002) and the third most common cause of cancer related death (Kaseb et al., 2009). It results in 598,000 deaths per year worldwide (Parkin et al., 2005).
Diagnosis of HCC depends on clinical evaluation, laboratory diagnosis, imaging techniques and histopathological techniques. The patient may be completely asymptomatic with no physical signs other than those of cirrhosis. So the laboratory markers of HCC are very important in early diagnosis for better prognosis (Kim et al., 2006).
Any cause of liver disease that can result in cirrhosis should be considered a potential risk factor for HCC. The most common causes of cirrhosis, namely HBV, HCV and alcohol, are also the most common causes of HCC (Davis et al., 2008).
The conventional and the most commonly used marker for HCC is alpha fetoprotein (AFP), but it has low specificity and unsatisfactory sensitivity in the diagnosis of early HCC. So there is need for supplementary markers for AFP to increase the sensitivity in early diagnosis of HCC as well as the specificity in differentiation between HCC and benign lesions (Kim et al., 2006).
Vascular endothelial growth factor (VEGF) is one of platelet-derived growth factor family. They are important signaling proteins involved in both vasculogenesis and angiogenesis (Grizzi et al., 2007). It has also been reported that VEGF expression can be found in many human tumor cells such as lung adenocarcinoma, bladder carcinoma, fibrocarcinoma, neuroglioma, gastric carcinoma, colon cancer and pancreatic cancer (Jinno et al., 1998).
In this regards, our study aimed at evaluation of the clinical utility of serum levels of VEGF in HCC patients and correlating it with the currently used biochemical marker for the diagnosis of HCC, AFP.
The present study included 116 patients with HCC, 30 patients with chronic liver diseases in addition to 30 apparently healthy individuals serving as a normal control group.
All subjects of the study were subjected to full history, detailed clinical examination, routine liver function tests including AST, ALT, albumin, total bilirubin, P.T., serum AFP and serum VEGF. Radiological investigations including CT scan, abdominal ultrasound to the HCC patients.
Peripheral blood samples were assayed for VEGF by sandwich ELISA technique employing two VEGF specific antibodies. Quantitation was achieved by the construction of the standard curve using known concentrations of VEGF.
Both serum VEGF and AFP were significantly higher in HCC patients when compared to the other two control groups (CLD & Healthy groups). Serum VEGF level was persistently elevated in HCC patients with normal AFP level.
There was no significant correlation found betweenVEGF and age aminotransferases, hemoglobin, platelets and while there was a significant positive correlation between VEGF and AFP, Child score & class, Okuda class and total bilirubin and a significant negative correlation with Albumin.
Assessment of the diagnostic performance of VEGF the best cut-off to discriminate HCC from CLD patients was ≥ 482 pg/mL, providing sensitivity, specificity, PPV, NPV and efficacy of 52.59%, 100.0%, 100.0%, 35.3% and 61.6% respectively. And the best cut-off to discriminate HCC and CLD from healthy control group was ≥ 280 pg/mL, providing sensitivity, specificity, PPV, NPV and efficacy of 60.27%, 100.0%, 100.0%, 34.1% and 67.0% respectively.
It may be concluded that VEGF could represent a useful marker for detection of HCC in patients with normal serum AFP, and for differential diagnosis between HCC and CLD as we found that HCC patients have higher levels of VEGF than CLD patients and healthy controls.