الفهرس 
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Abstract
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. Therefore the laboratory markers of HCC are very important in early diagnosis for better prognosis (Filmus et al., 2004).
The conventional and the most commonly used marker for HCC is AFP, but it has low specificity and unsatisfactory sensitivity in the diagnosis of early HCC. Thus, 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 (Wei et al., 2006).
Total AFP can be divided into three different glycoforms, namely AFP-L1, AFP-L2 and AFP-L3, according to their binding capability to lectin lens culinaris agglutin. Some clinical researches have indicated that the high percentage of AFP-L3 is closely related to poor differentiation and biologically malignant characteristics, especially portal vein invasion as it is produced only from malignant liver cells of HCC (Lin et al., 2006).
The present study included 46 patients with HCC regardless of the underlying etiology. The second group included 20 patients with benign hepatic disorders such as chronic hepatitis and liver cirrhosis. 20 sex- and age- matched healthy individuals were serving as a normal control group.
All studied cases of HCC were submitted to clinical examination and radiological investigations, routine liver function tests and serum AFP and AFP-L3.
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In this study,we found that the median value of both serum AFP-L3 and AFP-L3/AFP ratio was significantly higher in HCC patients group when compared to chronic liver disease patients and normal control individuals.
There was a significant positive correlation between each of serum AFP, AFP-L3, with each of child classification, tumor size and tumor number, among HCC patients. A significant correlation was found between AFP and AFP-L3/AFP ratio among HCC patients.
Receiver operator characteristics (ROC) curves were constructed for serum AFP, AFP-L3 and AFP-L3/AFP ratio as predictors of HCC. Serum AFP-L3 had the largest area under the curve (AUC) when compared to serum AFP and AFP-L3/AFP ratio.
The best cut-off point for AFP as predictor of HCC was 62 ng/mL (sensitivity 83%, specificity 80%, PPV 91%, NPV 67% and efficacy 82%). The best cut off point for AFP-L3 as predictor of HCC was 15 ng/mL (sensitivity 83% specificity 85%, PPV 93%, NPV 68% and efficacy 83%). The best cut-off point for AFP-L3/AFP ratio was 20 % (sensitivity 70%, specificity 75%, PPV 87%, NPV 52% and efficacy 71%). Combination of AFP and AFP-L3 (subjects considered having HCC when being positive for AFP and-or AFP-L3) revealed best cut-off of AFP at 100 ng/mL and AFP-L3 at 4 ng/mL giving sensitivity of 100%, specificity of 85%, PPV 94%, NPV100% and efficacy 96%.
In conclusion AFP-L3 is a promising marker for diagnosis of HCC especially when combined with AFP as the diagnostic sensitivity was optimum so both markers can be used in the screening of HCC.
The increasing incidence of HCC, in addition to the fact that the majority of these tumors are diagnosed at a late stage when curative treatments are not possible, implicate that
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performing regular surveillance of high risk individuals is recommended.