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العنوان
A Comparative Study of the Diagnostic and
Prognostic Value of Macrophage Activation
Marker Soluble CD163 and Alpha Fetoprotein
in Cirrhotic Patients with Hepatitis C Virusrelated
Hepatocellular Carcinoma treated by
Loco-Regional Therapy /
المؤلف
Sakr, Marwa Ahmed Mohamed Mohamed.
هيئة الاعداد
باحث / Marwa Ahmed Mohamed Mohamed Sakr
مشرف / Khaled Abd El-Hamid Mohamed
مشرف / Eslam Safwat Mohamed
مناقش / Mohamed Hassan Ahmed Fouad
تاريخ النشر
2019.
عدد الصفحات
192 P. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الطب الباطني
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم الباطنة العامة
الفهرس
Only 14 pages are availabe for public view

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from 193

Abstract

H
epatocellular carcinoma is the fifth most common tumor worldwide and the second most common cause of cancer-related death with a male-to-female predominance greater than 2:1.
The presence of cirrhosis represents a key risk factor for the development of HCC. The prevalence of cirrhosis among patients with HCC has been estimated to be 85%-95% and the HCC incidence rate among patients with cirrhosis has been shown to be 2%-4% per year.
HCV infection is a leading cause of liver cirrhosis and hence the development of HCC. Egypt has the highest HCV prevalence worldwide; with estimated rate of 10% of Egyptians between 15 – 59 years as reported by the Egyptian Health Issues Survey (EHIS) in 2015.
HCC is an inflammation-related cancer, as a chronic inflammatory state is necessary for cancer appearance.Tumor associated macrophages (TAMs) are the prominent population of infiltrating leukocytes and the major source of inflammatory cytokines in the tumor milieu. Upon activation, macrophages can release a vast diversity of cytokines, proteolytic enzymes, growth factors and inflammatory mediators that may directly influence the behavior of tumor cells. Generally, the M1 phenotype could secrete reactive oxygen and nitrogen intermediates to kill cancer cells. The M2 phenotype has the opposite effects. They release vascular endothelial cell growth factor (VEGF), tumor transforming growth factor (TGF)-β and IL-10 that promote cancer cell growth.
Macrophage associated markers have raised interest as possible predictors of the presence and progression of HCC. One of these markers is CD163, which is located exclusively on the surface of macrophages and monocytes. CD163 is shed from the cell surface into the circulation upon macrophage activation, and is thus a highly specific marker of macrophage activation. The soluble form of CD163 (sCD163) has shown promising capacity as a biomarker of the severity and outcome of various liver diseases, including HCC.
The aim of this study is to evaluate the diagnostic value of serum level of macrophage activating marker soluble CD163 as a tumor marker for HCC and its prognostic value after transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), in comparison to alpha-feto protein (AFP).
The study included 60 subjects divided into two groups: group I was 40 randomly patients with hepatitis C related hepatocellular carcinoma (excluding BCLC class D),among them there were 4 had portal vein invasion and 36 underwent intervention with TACE or RF. group II was 20 patients with liver cirrhosis without hepatocellular carcinoma as a control.
All patients subjected to the following:
1. Full history taking.
2. Full clinical examination with special emphasis on the presence of signs of chronic liver disease (spider naevi, palmar erythema, level of consciousness, flapping tremors, ascites, splenomegaly, jaundice) or signs of hepatocellular carcinoma (cachexia, loss of weight, refractrory ascites)
3. Routine laboratory investigations including: complete blood count, serum creatinine and blood urea nitrogen, serum alanine aminotransferase, serum aspartate aminotransferase, serum alkaline phophatase, total and direct bilirubin, serum albumin and total proteins, prothrombin time for assessment of the child score.
4- Viral markers:
Hepatitis C virus antibody, Hepatitis B virus surface antigen (HBsAg)
5- Serum Alpha fetoprotein
6- Radiological study:
 Abdominal ultrasonography to assess the presence of liver cirrhosis, ascites and hepatic focal lesions
 Tri phasic spiral CT abdomen: CT is done in different phases of contrast enhancement (early and late arterial and portal venous phases) it will be done for any patient showing a suspected focal lesion in the abdominal ultrasound.
 Dynamic MRI; if spiral CT is non conclusive.
7- Measurement of Serum soluble CD163 for all patients before intervention.
8- Follow up of the patients who had HCC and undergone either RFA or TACE will be done after 1 month by measuring serum level of alfa feto protein and serum soluble CD163 and triphasic spiral CT.
This study showed that:
Serum soluble CD163 levels did not differ significantly between HCC group and liver cirrhosis group and it not suitable for diagnostic use.
Soluble CD163 showed direct significant correlation with liver enzymes (AST and ALT levels) and Child Pugh Score.
Soluble CD163 levels in the HCC group were affected by number of the tumor and overall size.
It was shown that the Basal CD163 had significantly high diagnostic performance in predicting the diagnosis of failure of treatment at cut off value of ≥7.8with sensitivity 100% and specificity was 90%. Also soluble CD163 after intervention had significant high performance in predicting the diagnosis of recurrence at cut off value of ≥ 5.0 with sensitivity 100% and specificity was 86.7%.
In conclusion, soluble CD163 is not suitable as a diagnostic marker for HCC but can be used as a prognostic marker for HCC.