الفهرس 
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Abstract
Hepatocellular cancer (HCC) has turn out to be the 2nd
commanding trigger of malignancy mortality globally.
Assessment of serum alpha-fetoprotein (AFP) level is a valuable and widely utilized marker for the detection and monitoring of HCC, the overall AFP performance has been inadequate in terms of its poor sensitivity and specificity.
Hence, novel markers that complement the drawbacks of AFP are crucial to for screening and more precise diagnosis of HCC. One of these studied biomarkers is chromogranin-A (CgA).
Therefore, the aim of this study was to highlight the value of determination of CgA serum levels in monitoring patients with cirrhosis for early detection of HCC and its significance as a prognostic marker in patients with very early/early stage of HCC before and after radiofrequency.
The current study was carried out on 60 subjects who attended to Gastroentrology clinics at Kafr El-sheikh General Hospital and Ain Shams University clinics during the period from August 2018 till December 2019 they were divided as 30 cirrhotic patients with very early/early stage of HCC and diagnosed by triphasic CT, cirrhotic patients without HCC, and 15 healthy subjects as control group.
As regard HCC markers, results revealed that both markers (AFP and Cg-A) were significantly higher in HCC patients compared to healthy controls, as expected. Moreover, the median levels of both markers were significantly elevated in HCC patients when compared to their levels in cirrhotic patients.
As regard correlation results, Cg-A correlated with all studied parameters except WBCs, PLTs, total bilirubin, and serum creatinine
In addition, the ability of the studied serum markers (AFP, and Cg-A) to detect the occurrence of hepatocellular carcinoma was assessed using non-parametric ROC curve analysis. The cut-off value for AFP was 3.736 (ng/ml) with 93.3% sensitivity and 86.7% specificity, and AUROC =0.927. In addition, the best cut-off values of AFP for diagnosing HCC patients before radio-frequency ablation procedure from that after receiving therapy was 17 (ng/ml) with
73.3% sensitivity and 70% specificity.
The results of the present study also showed that the best ROC curve was that of the Cg-A (AUROC = .990). The selected cut- off values for diagnosing HCC patients from liver cirrhosis was 250 (ng/ml) for serum Cg-A with 96.7% sensitivity and 93.3% specificity. And the selected cut-off values for diagnosing HCC patients before radio-frequency ablation procedure from that from after receiving therapy was 375 (ng/ml) with 96.7% sensitivity and 76.7% specificity.