الفهرس 
Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
HCC is widely distributed all over the world and represent the fifth most common cancer affecting the patients and the third most common cause of cancer-associated deaths. In Egypt, HCC is the second most common tumour in men and the 6th most common tumour in women. Hospital-based studies from Egypt had reported an increase in the relative frequency of all liver-related tumours in Egypt, from about 4% in 1993 to 7.3% in 2003. This rising incidence is likely due to high prevalence of hepatitis C virus (HCV) and its complications.
Egypt has the highest HCV incidence worldwide accounting for 14% of the general population. chronic HCV infection mostly leads to liver cirrhosis before developing HCC. HCV is a RNA virus so, cannot integrate into the host genome. The carcinogenesis of HCV-associated HCC is a multistep process involving upregulation of inflammatory cytokines and induction of oxidative stress from chronic hepatitis, fibrosis, liver regeneration, and the development of cirrhosis. HCV may also play a direct role in hepatic carcinogenesis through involvement of viral gene products in inducing liver cell proliferation .the risk of HCC in patients with chronic HCV is highest among patients who have cirrhosis where the incidence of HCC is between 2%-8% per year.
Vitamin D deficiency is the most common nutritional deficiency and one of the most common undiagnosed medical state in the world. Vitamin D deficiency is related to many cancers including cancer colon, breast carcinoma with inconclusive data for HCC.
The aim of the study is to evaluate the possible role of vitamin D insuffiency in HCV related HCC development with detection of possible prognostic role in HCV related HCC .
This study was conducted at Ain Shams University Hospitals on two groups of subjects each of 30 subjects. A group of control subjects with chronic HCV infection whatever the Child score but without HCC and a group of HCC patients on top of chronic HCV infection which are followed before and after the therapeutic and palliative intervension for the HCC with measurement of vitamin D in both groups with its measurement before and after the intervension to study the possible diagnostic and prognostic effect of vitamin D.
This study found statistical significance between cases and control as regard total bilirubin and albumin and statistical significance between cases and control as regard Child-Puch score while no statistical difference between both groups as regard other liver function tests. This can be explained by the inclusion criteria of the control group which patients are mostly decompensated by manifestations of liver cell failure while the cases are all HCC patients with intervensions as RF or TACE done which recommend that they are Child A or B and not so marked decompensated.
This study found no statistical significance for measurement of vitamin D in the cases of HCC before the intervension which signifies no significant role of vitamin D measurement in the diagnosis of HCC.
This study found high statistical significance between cases and control as regard vitamin D level in the cases group after the intervention in which vitamin D increases significantly after the loco-regional intervension without systemic vitamin D supplementations which signifies that there may be possible prognostic effect of vitamin D measurement in the HCC patients fit for the intervension while there was no statistical significance between the different types of the intervention on the degree of change of vitamin D.
This study found no statistical significance between the degree of change of vitamin D with age, number of focal lesions, UGIE findings and Child score with no statistical difference for the correlation between Vitamin D level (Before and after the procedure), and degree of change of Vitamin D with laboratory data.
The study concluded that vitamin D measurement has no statistical significant role in the diagnosis with statistical significant role in the prognosis for the HCC patients fit for loco-regional intervensions with the best sensitivity (60%) and specificity (56.7) for prediction of HCC at cut off value ≤ 19 ng/ml with no significant role for DEXA scan for HCC diagnosis or prognosis.