الفهرس 
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Abstract
H
epatocellular carcinoma (HCC) is the fifth most common malignancy and the third leading cause of cancer-related deaths. Until recently; alpha feto protein (AFP) has been the most widely used plasma marker for diagnosis, surveillance and as a prognostic indicator of HCC patients’ survival but it has a low sensitivity, and specificity.
Several tumor markers have been proposed as complement or substitute for AFP in HCC diagnosis. Recently, Lens culinaris agglutininA-reactive fraction of alpha-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) have been established as HCC-specific tumor markers. However AFP-L3 and DCP are less sensitive than AFP for the diagnosis of early and very early stage of HCC.
Chromogranin A (CgA) is a member of the granin family of neuroendocrine secretory proteins; it is located in secretory vesicles of neurons and endocrine cells. Low levels of CgA in the circulation represent in healthy subjects and are independent of age and sex. Recent studies reported elevated levels of serum CgA in HCC patients, suggesting a possible diagnostic role of this marker.
The aim of this study was to investigate the role of serum chromogranin A as a marker for detection of HCC and to assess the difference in the level of serum chromogranin A in patients with hepatocellular carcinoma (HCC) complicating chronic hepatitis B and C.
This study included four groups (group I and II are test groups while group III and IV are control groups); group (I) (HBV-related HCC group) consists of 15 patients with hepatocellular carcinoma complicated chronic hepatitis B. While group (II) (HCV-related HCC group) consists of 30 with hepatocellular carcinoma complicated chronic hepatitis C. group (III) (Cirrhotic group) consists of 15 patients with liver cirrhosis. group (IV) (control group) consists of 15 healthy subjects with negative viral marker.
In our study we found that there were statistically significant differences between the HCC groups and control groups regarding the CBC, BUN, albumin, PTT, PT, ALT, AST, T.bil and D.bil.
As regards the median levels of CgA, there were statistically significant differences between the HCC groups and control groups.
No significant correlations were found between chromogranin and Age, CBC, kidney functions and other liver function tests.
There was no statistically significant elevation between the median serum CgA in HBV-related HCC and HCV-related HCC.
For AFP At cut-off value (200 ng/ml) it has a sensitivity 33.3% specificity 100% with PPV 100% & NPV 60%, while at cut-off of 20 ng/ml sensitivity was 66.67% but specificity was 90.0 % with PPV 90.91% & NPV 64.25%.
For CgA at a cutoff 100 ng/ml the sensitivity was 77.78% and the specificity was 93.3% with PPV 94.59% & NPV 73.68%.
This study shows a significant high positive correlation between chromogranin and AFP in HCC patients.
Regarding the HCC size and number there were no significant differences between the levels of CgA regarding tumor size or number.
Regarding the combination between the sensitivity and specificity of CgA at cut off level 100 ng/ml and AFP at cut off levels (20,200) ng/ml (considering the test positive if one or both of them are above the cut off value) it showed sensitivity 97.78 % and specificity 86.67 % at cut off level 20ng/ml, That’s led to increase in the sensitivity of AFP from (66.7%) to (97.78%) but decrease the specificity from (90%) to (86.67%), and at cut off level 200 ng/ml sensitivity 86.67% and specificity 93.3 %, that’s led to increase in the sensitivity of AFP from (33.3%) to (88.8%) but decrease the specificity from (100%) to (93.3%).