ABSTRACT
A sound predictive test is lacking for the identification of cirrhotic patients at high risk of developing hepatocellular carcinoma. In the present study, plasma MMP-9, plasma clCAM-1, serum alpha-feto protein [AFP] and serum PIIIP levels were measured and evaluated in 30 patients suffered from chronic hepatitis [CH], 30 patients suffered from liver cirrhosis [LC] and 30 patients suffered from hepatocellular carcinoma [HCC], in addition to 30 normal healthy individuals as a control group using RIA method for estimation of PIIIP and ELISA methods for estimations of the AFP and clCAM-1 and MMP-9. The study showed that the mean values of plasma MMP-9, plasma clCAM-1, serum PIIIP and serum AFP levels were 44.8 ng/ml, 232.1 ng/ml, 3.4 ug/l, 3.2 ng/Ml respectively among control group, 88.61 ng/ml, 489.5 ng/ml, 11.5 ug/l, 8.7 ng/ml respectively among Chronic hepatitis patients, 96.6 ng/ml, 781.3 ng/ml, 13.9 ug/l, 26.5 ng/ml respectively among Liver cirrhosis patients and 212.1 ng/ml, 999.4 ng/ml, 26.6 ug/l, 784.6 ng/ml respectively among HCC patients. Plasma MMP-9, plasma clCAM-1, serum PIIIP and serum AFP showed statistically highly significantly increase in all patients groups [P <0.001] when compared with the healthy control group. Plasma MMP-9 showed statistically highly significant increase in HCC group when compared with CH and LC groups, while did not show any statistically significant change [P> 0.05] in CH and LC groups when compared with the control group or with each other. clCAM-1 showed statistically highly significant increase in LC and HCC groups when compared with CH group with no significant change between LC and HCC groups and lastly serum AFP and PIIIP levels showed statistically highly significantly increase in HCC group when compared with CH and LC groups. As regard HCC histopathological grading all measured parameters showed statistically nonsignificant changes in different HCC grades except MMP-9 which showed a statistically significant increase in grade III when either compared with grade I or grade II. Receiver operating characterstic curve [ROC curve] was constructed using multiple cut off points for every studied parameter and calculating the sensitivity and the specificity at each cut off point and also calculating the area under each curve. The optimum cut off point for diagnosis of HCC from CH and LC for plasma MMP-9, plasma clCAM-1, serum PIIIP, and serum AFP were 89.8 ng/ml, 905 ng/ml, 25.8 ug/L and 68 ng/ml respectively, also, the study showed that AFP was the best of the studied HCC markers as it had the biggest area under ROC curve [0.86] followed by MMP-9 [0.76], cICAM [0.715] and lastly PIIIP [0.71]