الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths.HCC most often develops in patients with a history of cirrhosis due to chronic alcohol abuse, non-alcoholic fatty liver disease, or hepatitis C virus (HCV) infection. HCC is characterized by the lack of specific symptoms in the early stages of the disease and poor prognosis. Biomarkers that distinguish HCC from inflammation and cirrhosis are desperately needed in order to enhance prognosis of these patients. Midkine (MK) is a cytokine or a growth factor and belongs to the carbohydrate-binding proteins. MK is overexpressed in many malignant tumors of humans, including hepatocellular carcinoma, gastric carcinoma, colon carcinoma, lung carcinoma, urinary bladder carcinoma, prostate carcinoma.The aim of this study was to evaluate serum Mid Kine as a marker for hepatocellular carcinoma in HCV-related liver cirrhosis.The study included 80 subjects who were distributed into 3 groups; group 1 that included 10 healthy control persons, group 2 that included 20 cirrhotic patients and group 3 that included 50 patients with HCC The cases were subjected to full history taking (including demographic data, history of the current disease and associated chronic disease) and full clinical examnation. Laboratory investigations were done including assessment of serum AFP levels. Serum midkine levels were measured using ELISA technique. Radiological investigations including US and CT were done for assessment of cirrhosis and disgnoais of HCC. The results of this study showed that: 1.The mean age of the cases showed no statistically significant difference between the study groups. 2.The sex distribution revealed a statistically significant difference between the study groups as the majority of the cases in HCC group were males (70%) while the majority of cases in control and cirrhosis groups were females. 3. All the tested laboratory parameters revealed high level of significance between the different study groups except the Hb and WBCs. 4. The median level of AFP in HCC group was higher than its median value in the other study groups with high level of significance between the study groups. 5. The median level of HCV Ag as detected by PCR didn’t reveal any statistically significant difference between cirrhosis and HCC groups. 6. The median level of midkine in HCC group was higher than its median value in the other study groups with high level of significance between the study groups. 7. In HCC cases this study, AFP was positive in 35 cases (70%) and negative in 15 cases (30%) while MK was positive in all HCC cases. 8. There was a statistically significant correlation between MDK levels with serum AFP levels, tumor size and tumour stage. 9. The cutoff point of midkine to differentiate between control group and cirrhosis group was 3980 pg/ml with 84% sensitivity, 81% specificity and total accuracy of 86%.
10. The cutoff point of midkine to differentiate between cirrhosis group and HCC group was 9020 pg/ml with 96% sensitivity, 92% specificity and total accuracy of 97%.