الفهرس 
Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
SUMMARY
L
iver cancer remains a global health challenge and its incidence is growing worldwide. It is estimated that, by 2025, >1 million individuals will be affected by liver cancer annually. Hepatocellular carcinoma (HCC) is the most common form of liver cancer and accounts for " ~ "90% of cases. Hepatitis B virus (HBV) infection is the most prominent risk factor for HCC development, accounting for " ~ "50% of cases.
Angiogenesis is a main factor in the development of HCC. Vascular endothelial growth factor (VEGF) is considered the force for physiological and pathological angiogenesis, and overexpression of VEGF is prominent in HCC.
Considering the importance of angiogenesis in the pathogenesis and treatment of liver cancer. Systemic therapies, the currently available multikinase inhibitors (sorafenib) primarily target angiogenic pathways.
The current study aimed to evaluate the level of VEGF before and after 3 months of treatment with Sorafenib and evaluate the efficacy of VEGF as a prognostic marker by correlating it’s level with the radiological response after 3 months of treatment with Sorafenib.
Thirty patients with BCLC-C or untreatable BCLC-B with a mean age of 62.9 years were included in the current study, they presented to our HCC clinics, Tropical Medicine Department, Ain Shams University Hospitals, in the period from June 2022 to June 2023.
HCV infection was the causative etiology of HCC in 93.3% of patients, 73.3% of which received treatment with 63.3% of them achieved sustained viral response.
All our studied patients were subjected before treatment to full history-taking especially complaints as 40% of them accidentally discovered HCC, clinical evaluation showed 80% of patients had performance zero and laboratory investigations as CHILD score showed that 56.7% of patients were CHILD A5, AFP more than 200 ng/mL in 43.3% of patients, VEGF level ranged from 457-3594 IU/ml and radiological assessment by Dynamic contrast study either triphasic CT or dynamic MRI was done.
All studied patients were subjected to the same evaluation 3 months after treatment by history-taking, clinical examination, laboratory investigation, and radiological assessment.
The current study showed significant deterioration of the patients’ clinical outcomes. As the CHILD score increased with a P value=0.003 and performance status deteriorated with a P value=0.01.
Regarding radiological assessment after treatment, there were 70% of the included patients showed progressive disease (PD) according to mRECIST while 60% of the included patients with PVT showed regression of portal vein thrombus extension.
Only 9 patients (30%) achieved disease control (DC) in the form of partial response (PR) or stationary disease (SD) in radiological assessment according to mRECIST.
Despite that Sorafenib achieved disease control in 30% of the patients, half of the studied patients experienced side effects of Sorafenib but was tolerated without the need to discontinue treatment within the three months of treatment.
So, we consider very special criteria for patients who will receive sorafenib with close follow-up to them during treatment.
In comparing the level of VEGF before and after treatment, it showed a decrease in 43.3% of patients and an increase in 56.7% of the included patients.
In the current study, we correlated the level of VEGF with the clinical and radiological data of the included patients before and after treatment and we found a positive significant relation between them after treatment only.
The VEGF levels before treatment still couldn’t predict either the clinical or the radiological outcomes of the patients.
The level of VEGF before treatment was not statistically significant with patient criteria after treatment, but the level of VEGF after Sorafenib treatment was significantly correlated with the radiological outcome as the highest value of VEGF after treatment was compatible with progressive disease and the lowest value of VEGF was compatible with partial response.
VEGF may be used as a prognostic marker in HCC patients, but preferably not to be used alone. It’s better to be used with other tumor markers as AFP and DCP.
VEGF alone is not a substitute for radiological assessment, it may be used as an add-on information in equivocal tumor behavior in radiological evaluation after Sorafenib treatment.