الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers in the world and is the most common primary malignant tumor affecting the liver. Its occurrence is always linked to cirrhosis, chronic infection with hepatitis B and C. Tumor markers are potential screening tools that are widely used for early diagnosis of tumors. The aim of Ideal tumor marker estimation in HCC is early detection (surveillance), particularly in the higher risk groups. While AFP is a commonly used tumor marker in the detection of HCC, about 35-40% of HCC patients may have normal AFP. In addition, AFP may be elevated in non-malignant liver diseases, so, AFP is still not a reliable indicator for detection of HCC particularly with small and early HCC. sCD25 is produced after proteolytic release from the membrane-bound α-subunit (CD25) of the interleukin (IL)-2 receptor. When CD25 is present on the T-cell membrane, together with the β and γ chains it forms the high-affinity IL-2 receptor that allows optimal IL-2 signaling for T-cell activation and proliferation. Increased CD4 (+) CD69 (+) CD25 (-) T cells in HCC patients are significantly correlated with tumor size, vascular invasion and TNM stage. Thus, increased CD4 (+) CD69 (+) CD25 (-) T cells exert a critical role in HCC progression and might be a clinically aggressive phenotype of HCC. Aim of our study is to verify the reliability of CD25 as a marker for diagnosis of HCC. This study was conducted at Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, National Liver Institute, Menoufia University and Ahmed maher teaching Hospital, Cairo. Sixty Egyptian patients with liver cirrhosis were recruited and were divided as follows: • group I: 30 patients with HCV liver cirrhosis and HCC (diagnosis of HCC will be based on the presence of typical vascular pattern of enhancement on triphasic spiral computed CT scan). • group II: 30 patients with HCV liver cirrhosis without HCC.
In addition 20 healthy subjects were enrolled in the study as a control group (age & sex matched). o Results: • As regard age of the studied groups: the mean age was (51.8±9.5) years in cirrhotic group, (58.6±8.8) years in HCC group and (42.5±8.4) years in control group and these results showed no significant differences between the HCC group and the other two groups (p-value > 0.05). • As regard sex of studied groups: Cirrhotic group included 23 males (76.7%) and 7 females (23.3%), the HCC group included 22 males (73.3%) and 8 females (26.7%) with no significant difference among studied groups (p=0.73) • AST level in cirrhotic group was not significantly lower than that of the HCC group (p=0.69), but AST level in controls was significantly lower than that of HCC group and cirrhotic group (p=0.002 and 0.0001 respectively). • ALT level in cirrhotic group was significantly higher than controls (p=0.004), but there was no significant difference between cirrhotic group and HCC group (p=0.79), Also there was no significant difference between HCC group and controls (p=0.08). • Albumin level in HCC group was significantly lower than controls (p=0.0001), Also albumin level in cirrhotic group was significantly lower than controls (p=0.0001).but there was no significant difference between cirrhotic group and HCC group (p=0.07). • Total bilirubin level in HCC group was significantly higher than controls (p=0.003), Also total bilirubin level in cirrhotic group was significantly higher than controls (p=0.03).but there was no significant difference between cirrhotic group and HCC group (p=0.95). • International normalized ratio (INR) level in HCC group was significantly higher than controls (p=0.0001), Also INR level in cirrhotic group was significantly higher than controls (p=0.0001).but there was no significant difference between cirrhotic group and HCC group (p=0.72). • Platelet count in HCC group was significantly lower than controls (p=0.0001), Also Platelet count in cirrhotic group was significantly lower than controls (p=0.0001).but there was no significant difference between cirrhotic group and HCC group (p=0.99).
• AFP level of HCC group was significantly higher than cirrhotic group and controls (P=0.0001 and 0.0001 respectively). There was no significant difference between cirrhotic group and controls (p=0.08). • CD25 level of HCC group was significantly higher than cirrhotic group and controls (P=0.0001 and 0.0001 respectively). Also CD25 in cirrhotic group was significantly higher than that of controls (p=0.0001). For AFP: At cut off point of 200 ng/ml, the sensitivity of AFP is 70%, specificity 80%, accuracy 76.5%, +ve predictive value 67.7%and –ve predictive value 82%. For CD25: At cut off point of 2275 ng/ml, the sensitivity of CD25 is 93%, specificity 42%, accuracy 60%, +ve predictive value 48.3% and –ve predictive value 91.3%. With combined use of AFP and CD25, the sensitivity is 66.6%, specificity 80.4%, accuracy 75.3%, positive predictive value 66.6% and negative predictive value 80%.