الفهرس 
HCC
Diagnosis of Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC), a highly prevalent and lethal cancer, is the sixth most common cancer and the third leading cause of cancer-related death worldwide.
The aim of the current study was to evaluate the role of inflammatory markers Neutrophil lymphocyte ratio and Platelet lymphocyte ratio (NLR & PLR) as biomarkers for diagnosis of HCV related HCC. Also to evaluate their role as early prognostic markers before and after different therapeutic interventions of HCC. One hundred and fourteen consecutive patients with HCC seen in the outpatient clinic of HCC Unit, Tropical Medicine Department, Ain Shams University Hospitals, in the period from January 2015 to March 2018, were enrolled into a database that was approved by the Institutional Review Board. This study was conformed to the standards of the Declaration of Helsinki and current ethical guidelines and was approved by the Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with local research governance requirements.
Study conducted on three main groups; HCC group (n=114), CLD group (n=30) and normal control group (n=30). HCC patients, had been sub-grouped to three main sub-groups; HCC underwent RFA (n=30), HCC underwent TACE (n=41) and best supportive care group (n=43).
All studied populations had history taking, clinical examination and laboratory investigations including NLR and PLR. Patients who underwent RFA or TACE, post intervention PLR and NLR were also calculated.
Studied population was matched regards age and gender. As regards clinical data; 70% of HCC Patients who underwent RF had no ascites and 30% had moderate ascites. 80% of HCC patients who underwent TACE had no ascites and 19% had moderate ascites, while in late stage, 62% had moderate and 6.98% had marked ascites.
Results of our study showed significant difference regarding NLR or PLR scores between different study groups. But, there was no statisticaly significant difference in the two HCC subgroups who underwent intervention as regards the comparison between Pre and post intervention levels of NLR and PLR.
For CLD patients and HCC patients; Child score showed significant difference between study groups. In intervention group, it ranged between 5-9 with mean 6.133 for RF group and 6.049 for TACE group. On the other hand, best supportive care group showed range from 5-11 child score and mean 8.488. Child score for CLD patients ranged from 5-6 (mean 5.033). Concerning BCLC classification; among HCC patients who underwent RF, 83.33% of patients were BCLC A while 16.67% were BCLC B and 0.00% were BCLC C and D. Regarding HCC patients who underwent TACE, 14.63% of patients were BCLC A, 80.49% were BCLC B, 4.88% of patients were BCLC C and 0.00% of patients were BCLC D. Regarding HCC patients who didn’t underwent any intervention, 0.00% of patients were BCLC A and B while 53.49% were BCLC C and 46.51% of patients were BCLC D.
As regards the laboratory findings, there was statistically significant difference between HCC and CLD patients as regards haemoglobin level, platelet count, s. albumin, and bilirubin. While there was no statistically significant difference between them regarding neutrophil and lymphocyte absolute count.
As regard AFP in the current study, pre-intervention AFP level was significantly higher in different groups of HCC patients in comparison to control group with significantly higher levels in patients who didn’t undergo any intervention in comparison to other groups of HCC patients. Its level was significantly higher in HCC patients who underwent RFA in comparison to patients who underwent TACE. While there was no significant difference regarding pre and post intervention levels of AFP between different study groups.
The best cut off value of NLR between study and control group was more than 3.32 with area under the curve 0.507, sensitivity 15.79% and specificity 90% and positive predictive value 75 and negative predictive value 36.
It was found that, the best cut off value of PLR between study and control group was less than 120.44 with area under the curve 0.679, sensitivity 86.84% and specificity 43.33% and positive predictive value 74.4 and negative predictive value 63.4.