الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
HCC is the most common primary liver cancer. Its incidence is clearly arising by the prevalence of major risk factors mainly hepatitis B and hepatitis C. The population at risk is composed of chronic liver patients at the stage of extensive fibrosis or cirrhosis. The monitoring programs of this population have allowed early detection of disease management to promote a radical therapy.Alpha fetoprotein, available in clinical practice, is not a sufficiently reliable marker to identify HCC patients, mainly due to its poor sensitivity. So the need for other tests for the diagnosis and screening of patients at risk of HCC is an important. Attempts have been made to improve the HCC specificity of AFP by measuring GP73 which is a type II Golgi-localized integral membrane protein that is normally expressed in epithelial cells of many human tissues.The aim of this study is to assess the clinical utility of Golgi protein GP73 in cases of hepatocellular Carcinoma in comparison with alpha feto-protein AFP. In addition, the Level of Golgi protein GP73 is evaluated after surgical resection of hepatocellular carcinoma.The study was conducted on 86 subjects divided into 3 groups Group I (This group included 38 patients with HCC. They were 35 males and 3 females with a mean age ± SD of 52.68±8.80. 10 of them were followed after hepatectomy to detect level of GP73 after treatment).Group II Chronic liver diseases CLD:They were classified into two subgroups: Liver cirrhosis (n=15): This subgroup included 15 patients with liver cirrhosis 10 males and 5 females with a mean age ± SD of 51.68±6.85 (49.2).Chronic hepatitis (n=10): This subgroup included10 patient with chronic hepatitis 8 males and 2 females with a mean age ± SD of 51.68±6.85 (55.4)Group III Control group ( This group included 13 apparently healthy subjects served as a control group they were 10 males and 3 females with a mean age ± SD of 51.38±9.91) .Patients were selected as regards the following exclusion criteria: none of the patients had bacterial or other viral infection, chronic renal damage, insulin-dependent diabetes mellitus (IDDM) and other malignant diseases. The patients undergoing interferon administration or immuno-suppressive therapy were also excluded from this study.All patient and control groups subjected to the following: full history taking, thorough clinical examination, abdominal ultrasonogrphy, and ultrasound guided liver biopsy was performed by true-cut needle or liver biopsy gun for the cirrhotic patients when possible, triphasic C.T. to patients with focal lesion. The following laboratory investigations were done: liver function tests including: ALT, AST, serum albumin, total and direct bilirubin , prothrombin concentration and INR, serum AFP was measured using (ELISA) method and hepatitis markers (HBsAg, anti-HBc and HCV antibody). Determination of Golgi Protein 73 (GP73) was determined by ELISA Kit For Golgi Protein 73.The result of this study revealed that:The serum levels of AFP was significantly elevated in chronic liver diseases and more elevated in HCC cases (P<0.001). There was no statistically significant difference in GP73 between CLD group and control group (P>0.05).There was high statistically significant difference in GP73 between HCC group and control group (P<0.001) and also there was high statistically significant difference in GP73 between HCC group and CLD group (P <0.001). Other, interesting findings in our study is that GP73 is significantly lower after surgery in comparison to its level before surgery. The Correlation study between GP73 and the other studied parameters revealed highly significant positive correlation between GP73 and both AST and AFP (P <0.001) and significant positive correlation between GP73 and ALT , ALP , total and direct bilirubin . There is no significant correlation between GP73 and age and INR. This study showed that serum GP73 levels were significantly higher in patients with HCC compared to those with chronic liver disease patients. For discrimination of HCC from healthy control cases, ROC curve show that the serum GP73 levels had the AUROC of 0.89 (95%CI: 0.81–0.98) and a sensitivity of 76.3%, specificity of 92.3%,the diagnostic accuracy was 80.4%,positive predictive value was 96.7%, negative predictive value was57.1% at cut off point 192ng/L, while, AFP had an AUROC 0.83 (95%CI: 0.71–0.95) and a sensitivity of 73.7%, specificity of 61.5% ,the diagnostic accuracy was70.6% positive predictive value was 84.8%, negative predictive value was44.4%,at cut off point 10.5ng/ml .
For discrimination of HCC from chronic liver disease cases, ROC curve show that the serum GP73 levels had the AUROC of 0.88 (95%CI: 0.79–0.96) and a sensitivity of 76.3%, specificity of 84%, the diagnostic accuracy was 83.3%,positive predictive value was 87.8%, negative predictive value was70% at cut off point 195ng/L, while, AFP had an AUROC 0.83 (95%CI: 0.72–0.93) and a sensitivity of 73.7%, specificity of 68% the diagnostic accuracy was 71.4%,positive predictive value was 77.8%, negative predictive value was63% at cut off point 10.5ng/ml .
Finally GP73 expression is highly increased in HCC patients. Its diagnostic performance is superior to that of AFP. Moreover GP73 is a useful marker for follow up of HCC patients after surgical hepatectomy.