الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Objective: To evaluate the diagnostic accuracy of TNF-α versus AFP as biomarkers for detection of hepatocellular carcinoma on top of HCV- related cirrhosis. To assess the treatment response by using TNF-α and AFP after loco-regional intervention of HCC. To assess the overall survival in intervention group and the conservative one. Methods: All patients in phase I were subjected to a thorough history and clinical evaluation. Laboratory tests including: CBC, liver function tests, virology markers, and serum tumor markers (AFP and TNF-α). Radiological diagnosis of HCC was done by US and triphasic CT. Further assessment of functional liver status and HCC class were done. The 26 patients after loco-regional therapy in phase II were subjected for assessment of treatment response by triphasic CT, assessment of AFP and TNF-α level and percent change at time of radiological assessment, and finally check patient survival at 3 months interval for one year. Results: Our study confirmed the high diagnostic accuracy of TNF-α in diagnosis of Egyptian patients with HCC related to HCV cirrhosis, with sensitivity of 100% and a specificity of 94.1% at a cutoff value of ≥30pg/ml. Overall accuracy (AUROC) of TNF-α and AFP were 0.998, and 0.764, respectively. Pairwise comparisons of ROC curves showed that AUC for TNF-α was significantly higher than that for AFP (p<0.0005). A high diagnostic accuracy for TNF-α for early detection of HCC among HCV related cirrhotic patients was confirmed in our study at cutoff level of ≥32.35pg/ml with sensitivity and specificity of 100% and 98%, respectively. Our study showed that the low specificity of AFP at the suggested cutoff level ≥20ng/ml for diagnosis of HCC (70.58%) can be augmented to 98.08% by adding TNF-α cutoff value of ≥30pg/ml in patients with AFP values between levels of 20-200 ng/ml. Conclusion: TNF-α serum level could be a reliable biomarker in the early detection of HCC in HCV related cirrhotic patients with an overall accuracy exceeding that of AFP. Combined use of TNF-α at cutoff value of ≥30pg/ml in patients with AFP values () 20-200 ng/ml can augment the low specificity of AFP for diagnosis of HCC at cutoff level ≥20ng/ml from (70.58%) to (98.08%) Beside its diagnostic value; it could be useful in: Assessment of local and metastatic tumor burden. Assessment of tumor. Assessment of response after loco-regional therapy of HCC. Prediction of complete ablation after loco-regional therapy of HCC. In contrary to AFP, TNF-α could not be helpful as a predictor of one year survival.