الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is a global health problem, ranking as the sixth most common malignancy and the third most frequent cause of cancer-related death worldwide. It accounts for approximately 600.000 deaths per years and it shows a wide geographical variation.
Its incidence is rising, mostly due to the diffusion of hepatitis B or C virus infection, alcohol related cirrhosis, and nonalcoholic steatohepatitis. Its incidence increases with advancing age and is more common in males.
Hepatocellular carcinoma tumorigenesis includes alteration in cellular proliferation markers, cell cycle regulators, suppressor genes, oncogenes and their receptors, apoptosis related factors as well as modification of genes involved in angiogenesis and immune response. HCC is usually diagnosed at an advanced stage resulting in limited therapeutic options and poor prognosis. The identification of prognostic biomarkers is an important issue since such markers could facilitate early detection of HCC. Furthermore, such biomarkers could display potential therapeutic targets for HCC.
Alpha- fetoprotein was discovered in the serum of HCC patients in 1964. It has been regarded as the most useful serum protein thus far for patients at risk for HCC. However, its sensitivity for detecting HCC ranges between 25%-60%, and its specificity is also low because serum AFP can also be detected in patients with cirrhosis (11%-47%) and chronic hepatitis (15%-58%).
Thanks to semiannual surveillance of the high-risk population by ultrasound and alpha fetoprotein, HCC is increasingly detected at early stage, when curative treatments can be employed.
GP 73 is a resident Golgi trans-membrane glycoprotein was found up-regulated in expression in virus-infected hepatocyte. Several recent studies indicate that GP 73 is one of the most promising serum markers for HCC.
YKL-40 is a member of the “mammalian chitinase-like proteins”. YKL-40 produced by cancer cells, inflammatory cells. It probably has a role in cell proliferation and differentiation, inflammation, protection against apoptosis, stimulation of angiogenesis, and regulation of extracellular tissue remodeling. Elevated serum level of YKL-40 has a potential prognostic value in several cancers.
The objective of this study was to assess the diagnostic values of YKL-40 and GP 73 protein in normal liver tissues and at different stages of liver disease progression (chronic hepatitis B, chronic hepatitis C viruses and HCC) compared with AFP for monitoring chronic hepatitis patients and early detection of HCC.
This study included 20 normal subjects and 80 patients divided into 4 main groups as follows:
Group I: this group included healthy normal control individual of both sexes.
Group II: chronic hepatitis patients were suffering from chronic hepatitis C infection (HCV).
Group III: chronic hepatitis patients were suffering from chronic hepatitis B infection (HBV).
Group IV: hepatocellular carcinoma patients (HCC).
The sera of all studied patients were subjected to the following biochemical investigations:
Serum alanine and aspartate aminotransferase activities (ALT &AST).
Enzymatic activity of alkaline phosphatase (ALP).
Determination of serum total bilirubin (T-Bilirubin).
Determination of serum level of alpha fetoprotein (AFP).
Determination of serum level of YKL-40 was estimated.
Determination of serum level of GP 73 was assessed
Results of the present study showed that:
AFP biomarker showed highly significant increase in HCC group.
YKL-40 showed highly significant change in HBV and HCV groups when compared with control group.
GP 73 was significantly increased by 147% in HCC group while, in HBV and HCV groups the changes accounted by 340% and 300% when compared to the control group.
GP 73 was more significant than AFP and YKL-40 in HCC.
The current evidence indicates that serum GP73 has HCC diagnostic efficacy superior to that of AFP and YKL40 and the clinical implementation of serum GP73 measurement as a standard test for HCC is recommended alone or in combination with AFP.
Conclusion:
from aforementioned results, GP 73 might be as useful marker in the diagnosis and screening of potential HCC patients when used alone or in combination with AFP and we need to be evaluated further in future studies using stricter criteria where significant difficulties for interpreting the present studies arose due to different cutoff values, and study populations.