الفهرس 
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Abstract
I
ncidence of hepatocellular carcinoma (HCC) has rapidly increased worldwide. HCC is the sixth most common malignancy and the third most common cause of cancer related death.
Several therapies have been proposed for these patients with proven survival benefits in the early-stage of HCC. These therapies comprise the surgical resection, various locoregional treatments including percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), trans-arterial chemoembolization (TACE) and radioembolization.
Hepatic resection for HCC is a main therapy for treatment in surgically candidate patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes.
We investigated the role of Transient Elastography and CAP in predicting portal hypertension in those patients. So, if it could replace the invasive procedure (hepatic venous pressure gradient). Also, their role in prediction of early HCC recurrence after surgical resection.
The present prospective cohort study enrolled 30 Egyptian patients with potentially resectable hepatocellular carcinoma referred to Tropical Medicine department and HCC Unit, Ain Shams University Hospitals.Thirty patients with HCC; candidate for surgical resection; were included in our study.We divided them into two groups according to presence or absence of portal hypertension. Assessment of portal hypertension was done by laboratory markers, upper gastrointestinal endoscopy and HVPG. Transient Elastography and CAP measurements was done for all patients. Patients were classified into two groups: group I, included patients with evidence of portal hypertension (excluded from surgery) and group II: included patients with no evidence of portal hypertension (underwent surgery).
Correlations was done between Transient Elastography readings and CAP readings with other parameters of portal hypertension. Patients underwent surgical resection were followed up for 6 months post liver resection to detect HCC recurrence.
The present study included 20 males and 10 females. The mean age was 57.73 ± 6.79 years.All the studied patients were child A.
There were clinically significant difference between the 2 groups as regard high BMI, splenomegaly, low platelets count, higher APRI score, higher FIB 4 score, presence of oesophageal and gastric varices, portal hypertensive gastropathy, Transient Elastography and CAP readings favoring presence of portal hypertension.
Then, AFP, Transient Elastography and CAP readings were correlated with the other parameters. There were statistically significant positive correlation between AFP and Transient Elastography, Spleen size and HVPG.
Also, there were statistically significant positive correlation between Transient Elastography readings in correlation to CAP, AFP, FIB 4, APRI scores, Spleen size and HVPG while there were statistically significant negative correlation between Transient Elastography And platelets count.
Also, when correlating CAP measurements with the other parameters, we found statistically significant positive correlation between CAP readings in relation to Transient Elastography, BMI, HSI score, Spleen size and HVPG.
There was no statistically significant role found between AFP in detecting clinically significant portal hypertension.Transient Elastography as well as, CAP had statistically significant role in detecting clinically significant portal hypertension and in discriminating between different categories of HVPG and different degrees of OV.
Positive correlation between Transient Elastography, CAP and HVPG was found. The best cut off point for Transient Elastography to detect significant Portal hypertension was > 18Kpa with sensitivity of 93.75%, specificity of 100.0% and AUC of 99.8. Also the cut off point for CAP to detect significant Portal hypertension was > 217 with sensitivity of 87.5%, specificity of 64.29% and AUC of 81.2%. While the cutoff point of the platelets count was 166 with sensitivity of 100%, specificity of. 86.67% and AUC of 100 %. The combination between transient Elastography and platelets counts showed sensitivity of 87.5%, specificity of 100.0% and AUC of 95.5%.LS measurements by Transient Elastography showed significant role in predicting early recurrence of HCC with P value of 0.011.
In conclusion, Transient Elastography and CAP measurements can be used as a useful non invasive tool in evaluating portal hypertension in HCC cases candidate for liver resection.