الفهرس 
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Abstract
HCC is the most common type of tumors that can develop as a primary cancer of the liver. Most cases of HCC are secondary to either a viral hepatitis infection (hepatitis B or C) or cirrhosis. In Egypt, hospital-based studies have reported an overall increase in the relative frequency of all liver-related cancers in Egypt (>95% as HCC) with increasing importance of HCV infection in the etiology of liver cancer, with declining influence of HBV and HBV/HCV co-infection. Early detection of HCC is mandatory for early intervention to resect or ablate the lesion which has better prognosis but require smaller tumor and good general condition. AFP is the main serological marker used in the diagnosis of HCC since it is secreted by about half of HCC. However, not all HCC are AFP positive or secrete elevated amounts of AFP into the serum. It is thus a poor screening tool, especially for small size HCCs. Also, large HCCs also occurred in absent or low range of AFP patients. So, various markers have been suggested for diagnosis of low- or normal-AFP HCCs. C-reactive protein was investigated by some studies for diagnosis and detection of prognosis of HCC patients with low AFP but PLR was examined by many studies for detection of only prognosis of HCC patients. This study was carried out to verify, C-reactive protein and the platelet-to-lymphocytes ratio in diagnosis of HCC in Egyptian patients with liver cirrhosis induced by chronic hepatitis C. The study was carried out on 90 individuals who were enrolled from tropical medicine department of Tanta university .They were divided into three groups; group I included 30 HCC patients with low alpha feto protein, group II included 30 HCC patients with elevated alpha fetoprotein, group III included 30 Cirrhotic patients due to chronic hepatitis C without HCC (as a control group). We determined the level of C-reactive protein and platelets-tolymphocytes ratio together with full clinical assessment, liver biochemical profile, CBC, abdominal US and triphasic CT for HCC patients. The results of the present study were as following: Comparing between all the studied groups according to CRP and PLR revealed that: there were significant differences among the studied groups as regards CRP with highest CRP level in group II (HCC patients with high AFP) then the group I and least level in group III. Also, there was a significant higher PLR in group III(Cirrhotic patients without HCC) when compared to group II and group I but there was no significant difference in PLR between group II and group I. When using ROC curve analysis to detect diagnostic accuracy of the investigated markers we found that; the cut-off value of AFP for the detection of HCC patients was >7.7ng/ml (sensitivity: 83.33%, specificity: 90%), for the detection of HCC cases low AFP from cirrhotic cases it was >5.9ng/ml (sensitivity: 73.33%, specificity: 76.67%). The cut-off value of CRP for detection of HCC cases from control was >13.7 mg/L (sensitivity: 95.0%, specificity: 86.67%) and for detection of HCC cases with low AFP from cirrhotic cases was >13.7 mg/L (sensitivity: 90.0%, specificity: 86.67%) while the cut-off value for detection of HCC cases with elevated AFP from cirrhotic cases was >28.3 mg/L (sensitivity: 90.0%, specificity: 90%) The cut-off value of PLR for detection of HCC patients from control was ≤53 (sensitivity: 88.33%, specificity: 46.67%) and for diagnosis of 99 HCC cases with low AFP from cirrhotic cases was ≤53 (sensitivity: 86.67%, specificity: 46.67%). While for the detection of HCC with elevated AFP from cirrhotic cases it was ≤47 (sensitivity: 70.0%, specificity: 73.33%). Combined PLR and CRP increased specificity for diagnosis of HCC cases from control (from 86% to 90%) than CRP alone with sensitivity of 96.6% and Combined PLR and CRP increased specificity for diagnosis of HCC cases with low AFP from cirrhotic cases (from 86% to 90%) than CRP alone while Combined PLR and CRP increased specificity for diagnosis of HCC cases with elevated AFP from cirrhotic cases (from 90% to 93%) and sensitivity (from 90% to 100%) than CRP alone. Conclusion • CRP level was significantly increased in HCC patients when compared to cirrhotic patients while PLR was significantly higher in Cirrhotic patients group when compared to HCC groups. • CRP can differentiate HCC patients in total and HCC patients with low AFP from cirrhotic patients with high sensitivity and moderate specificity while PLR can differentiate HCC patients and HCC patients with low AFP from cirrhotic patients with moderate sensitivity and low specificity. • Combined PLR and CRP increased specificity for diagnosis of HCC cases from control than CRP alone. • Combined PLR and CRP increased specificity for diagnosis of HCC cases with low AFP from cirrhotic cases than CRP alone • Combined PLR and CRP increased specificity and sensitivity for diagnosis of HCC cases with elevated AFP from cirrhotic cases than CRP alone. Recommendations • 100 Recommendations Planning a screening program for early diagnosis of HCC is mandatory for early management and prevention of complication as decompensation and metastasis. We recommend the use of C-reactive protein as a cheap, rapid, easily applicable test and with high sensitivity and moderate specificity for early diagnosis of HCC in cirrhotic HCV patients. We recommend the combination between PLR and CRP to improve sensitivity and specificity of tumor detection. We recommend the use of PLR and CRP as a reliable marker for HCCs patients with low serum AFP levels.