الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, the fifth most common cancer and the third most common global cause of cancer-related death. The incidence of HCC in the developed world is comparatively low, apart from high rates in Japan, but there has been a steady overall increase across most Western nations over the last two decades. For almost all countries, males have higher rates of HCC incidence than females with a ratio of 2:1.
The age of patients diagnosed with HCC varies between sexes and geographical regions. In most regions, female incidence rates peak 5 years later in age compared with males. The change of incidence appears to be affecting the aging population most profoundly. The major risk factors for HCC are the presence of cirrhosis, and HBV/HCV infection. Other factors, such as AF and nonalcoholic steatohepatitis (NASH), are important and prevalent in certain areas of the world. With the exception of HBV and AF, all other etiological risks for HCC are associated with cirrhosis.
The clinical symptoms and signs of HCC are often absent in the early stages, or nonspecific when associated with end-stage liver disease. Surveillance for HCC should be performed using ultrasound at 6–12-month intervals and AFP should not be used unless ultrasound is unavailable. Serum AFP is a widely used marker of HCC. However, it remains insensitive and nonspecific in certain circumstances and is, therefore, imperfect, particularly in the detection of early, small cancers. Values of over 400 ng/ml are generally considered diagnostic of HCC, although only approximately 20% of patients with HCC display values this high. Indeed, only 30% of patients with HCC have been found to have values greater than 100 ng/ml.
Lens culinaris agglutinin-reactive AFP (AFP-L3) can be detected in approximately a third of patients with small HCCs. Higher AFP-L3 levels correlated with poorly differentiated tumors, compared with well-differentiated tumors. AFPL-3, also, acts as a marker of clearance of HCC after treatment and as a predictor of recurrence.
Despite technical improvements in all modes of HCC diagnostic imaging, difficulties remain in accurately identifying small (< 2 cm) lesions on the background of cirrhosis in all imaging modalities .With numerous treatment options available, a treatment strategy based on available evidence is essential for the optimal management of HCC.
Small (< 2 cm), early-stage tumors with background Child’s A cirrhosis and no portal hypertension are amenable to curative resection. If up to three tumors less than 3 cm are present with background liver disease, then liver transplant is an option. Alternatively, if comorbidities are present that contraindicate transplantation, percutaneous ethanol injection or radiofrequency ablation remain an option. Multinodular, intermediate-stage tumors are amenable to chemoembolization. It is possible that advanced-stage tumors might receive some benefit from a trial of sorafenib.
The aim of this work was to evaluate the diagnostic accuracy of AFPL3 (Lens cullinaris agglutinin-reactive AFP) against total AFP in the diagnosis of HCC.
This study included one hundred patients, eighty patients had HCC (Twenty with HCC before TACE, twenty with HCC after TACE, twenty with HCC before RFA and twenty with HCC after RFA) and twenty patients had chronic liver disease as a control group. All patients included in the study subjected to:
- Thorough history taking and clinical examination.
- Routine Lab. Investigations such as CBC, liver function test etc.
- Radiology: U/S study of the abdomen and Tri phasic CT of the abdomen.
- Tumor marker measurement including AFP and AFPL3.
Our results showed that the mean value of AFPL3 in the HCC group was significantly higher than that in the control group. There was no significant difference between the mean value of AFP in both groups. The maximum area under the curve (AUC) for the diagnosis of HCC using AFPL3 was significantly different from that of total AFP. There was significant decrease in the median value of AFPL3 after interventions. Also, there was significant difference in the median change of AFPL3, PT activity and albumin level between TACE and RFA.
We concluded that; early diagnosis of HCC allows early therapeutic intervention and thus better disease control. Total AFP has suboptimal performance both in diagnosis and screening of HCC. AFPL3 is more sensitive and specific for diagnosis of HCC than total AFP. AFPL3, not only acts as a marker for HCC diagnosis but also as a prognostic factor to evaluate therapeutic efficacy. RFA is a safe and effective therapy for HCC and has lesser impact on liver functions than TACE.
We recommend the following:
- Patients at risk of developing HCC should be screened at regular intervals to allow early detection of HCC and thus early intervention.
- Total AFP alone should not be used for HCC screening unless US is not available.
- Serial measurement of AFPL3 after therapeutic interventions should be done to evaluate therapeutic efficacy and detect disease recurrence.