الفهرس 
Chapter (1): Hepatocellular carcinomaOnly 14 pages are availabe for public view
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Abstract
HCC is now the fifth-most common cancer in the world and the
third cause of cancer-related mortality as estimated by the World Health
Organization. It is estimated that in 2012, there were 782,000 cases
worldwide, of which 83% were diagnosed in less developed regions of
the world.
In African and Asian countries, the diagnosis of HCC at earlier ages
is attributed to a synergy between HBV and dietary aflatoxins, which is
thought to induce mutations in the TP53 gene. Other factors such as
insertional mutagenesis and family history could play a role in the
development of HCC at earlier ages. In all areas, males have a higher
prevalence than females, the sex ratio usually ranging between 2:1 and
4:1, and, in most areas, the age at diagnosis in females is higher than in
males.
HCCs are not homogeneous and certain HCCs may have normal or
only mildly elevated levels of AFP compared with healthy individuals.
The highest sensitivity and specificity of AFP for diagnosis of HCC (60–
80% and 70–90%, respectively) was achieved at a cut of value of 16
nm/ml, but AFP was not expressed in approximately 30–40% of patients
with HCC, which makes this diagnostic approach less reliable.
The study aimed to identify the role of serum Aldo-keto reductase
family 1 member B10 as a screening test for early detection of
hepatocellular carcinoma.
The present study was carried on 80 patients classified into 30
patients with HCV related liver cirrhosis without HCC, 30 patients with
positive HCV cirrhosis, and HCC. The selected patients were compared
to twenty controls matched for age and gender. The controls were healthy
volunteers.
Summary
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Inclusion criteria: Patients with HCV related liver cirrhosis with or
without HCC.
Exclusion criteria:
- Patients underwent treatment for HCC.
- HCC patients with distant metastasis.
- Patients with malignancies other than HCC.
- Etiology of liver cirrhosis other than HCV.
- HCC Patients with HE
- Advanced HCC patients (multi lopular and PV thrombosis)
All the patients included in this study were subjected to:
A purposely designed sheet was performed for all patients included
in this study, including:
- Full datils history
- Complete physical examination: with particular emphasis on signs of
chronic liver disease (ascites, tremors, icterus)
Laboratory investigations: including complete blood picture,
liver, kidney functions, alpha feto protein, HBsAg, anti-HCV Ab and
AKR1 B 10.
Assessment of degree of hepatic fibrosis and degree of hepatic
decompensation
- The Child-Pugh score
- The Model for End-Stage Liver Disease
- The FIB-4 score
- APRI score (ALT to platelet ratio)
Imaging techniques:
- Abdominal ultrasound for all patients (splenic size, PV diameter,
ascites, collaterals).
Summary
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- Triphasic C.T scan for patient with HCC (HCC size - location – HCC
numbers)
Results of the current study:
There was no statistically significant difference among the studied
groups as regard age, sex, and BMI (p value >0.05).
There was no significant difference among groups A and B regarding
clinical data (icterus, tremors and ascites).
There was no significant difference among groups A and B regarding
history of GIT bleeding, history of hepatic encephalopathy, oedema
lower limb and history of blood transfusion
Platelet count was significantly lower in cirrhosis group than HCC
group. (P= 0.002), Also platelet count was significantly lower in HCC
group than controls (P= 0.001).
There was significant difference among the studied groups regarding
blood urea, serum creatinine, ALT, AST, total bilirubin, albumin, ALK
and GGT (P<0.05).
There was no statistically significant difference among the studied
groups as regard INR (P=0.3).
In group A, AFP level was significantly higher than group B and C (P=
0.001 both). Also, AFP level was significantly higher in group B than
group C (P= 0.001).
60% of HCC group had right focal lesion and 40% had left focal
lesion. All patients had single focal lesion. Mean size of lesion was
9.67±2.45 (range 7.34-15.2 cm).
There was highly statistically significant increase in HCC group as
regard spleen size than liver cirrhosis group (P <0.001).
There were no statistically significant differences between group A and
B regarding Child-Pugh score (p=0.902).
Summary
91
There was statistically high significant increase of AKR1B10 level in
HCC group compared to liver cirrhosis and controls groups (p=0.001
for each). Also, AKR1B10 level was significantly higher in group B
than group C (P= 0.001).
There was no statistically significant difference between HCC patients
and liver cirrhosis group regarding FIB4 score MELD score and APRI
score (P> 0.05).
ROC analysis showed that AUC was 0.828 for AKR1B10 and had
sensitivity 86.7% and specificity 70% in HCC.
ROC analysis showed that AUC was 0.705 for alpha fetoprotein in
HCC.
There was a negative significant correlation between AKR1B10 and
FIB4, INR, HB and total bilirubin in HCC patients (P= <0.05). While
positive significant correlation was found between AKR1B10 with
number of focal lesions, WBC, and AST (P<0.05).
ROC analysis showed that Alpha fetoprotein combined with
AKR1B10 had sensitivity of 97.6% and specificity of 100% AUC of
0.867 in detection of HCC.