ABSTRACT
Hepatocellular carcinoma [HCC] is considered the fifth most common cancer in the world. Owing to its increased incidence in the last decade and the expected further increase in the next 2 decades, HCC is arousing great interest. HCC commonly develops on cirrhotic livers and therefore, surveillance programs have been suggested to identify early HCC, at a stage suitable for surgical or interventional therapy and has a better clinical outcome. The only serologic marker used in clinical practice is alpha-fetoprotein [alpha-FP], but its sensitivity is poor. Hence, the investigation of new markers is required. To assess the clinical utility of squamous cell carcinoma antigen [SCCA] as a non invasive marker in the early diagnosis of HCC and whether the association of alpha-FP and SCCA could improves the diagnostic power. This study is conducted on 65 newly diagnosed hepatic focal lesion cases from those attending the Tropical Medicine Department, Cairo University Hospitals [Group I] as well as 20 age and sex matched healthy control subjects [Group II]. Group I was further subdivided into la [49 HCC proved untreated patients] and Ib [16 patients with Cirrhosis only] according to their histopathological findings. All patients were subjected to full history taking, clinical examination, laboratory investigations [including liver function test, hepatitis markers, alpha-FP and SCCA serum levels], triphasic abdominal CT and pathological examination. Group I included 42 males [64.7%] and 23 females [35.3%] with ages ranging between 42-70 years [60.7111.28], of them 16 patients had HBV [24.6%], 37 patients had HCV [56.9%] and 12 patients [18.4%] had mixed HBV and HCV infection. Group I was further subdivided into group la which included 49 HCC proved patients and group Ib which included 16 patients with regeneration nodules [cirrhosis only] according to their histopathologic findings. Group II [control] included 20 age and sex matched healthy subjects. Mean levels of serum alpha-FP and SCCA in group Ia was significantly higher when compared with group Ib [p<0.0005 for both of them]. At a cutoff of serum alpha-FP 200 ng/mL, the sensitivity was 35% and the specificity was 100% while at a cutoff >400ng/mL, the sensitivity decreased to 7.6%. On using the receiver operator curve [ROC], to improve the specificity and sensitivity of alpha-FP and SCCA, the cutoff value of 40ng/ml and 0.55ug/L yielded a sensitivity of 67.2% and 61.2% respectively and specificity of 100% [best cutoff]. When combined sensitivity of them was calculated at the best-chosen cutoff values, sensitivity improved to 87.7% with specificity of 100%.Combined use of alpha-FP and SCCA in the screening of patients with hepatic focal lesions may increase the chance of diagnosis of HCC patients
Subject(s)
Humans , Male , Female , Biomarkers, Tumor , Antigens, Neoplasm , alpha-Fetoproteins , Early Diagnosis , PrognosisABSTRACT
This study was performed on 78 patients having liver cirrhosis with 91 focal hepatic lesions detected by ultrasound and proved histopathologically to be HCC [biopsy and/or fine needle aspiration cytology; FNAC]. They were 70 males and 8 females their ages ranged between 37 and 75 years old. Patients were classified into three groups, Group A was formed of 32 patients with 37 focal lesions where they received RFA. Group B encountered 25 patients with 26 focal lesions and they received PAI Group C included 21 patients with 28 focal lesions were treated by PEI. Complete ablation was assessed by re-biopsy and/or FNAC, triphasic CT and AFP serum level. As regards the outcome of therapy in group A, complete ablation was achieved in 14/18 [78%] for lesions = 3cm and in 11/17 [65%] for lesions ranging between 3-5cm. In group B, complete ablation for lesions = 3cm occurred in 100% of cases while in lesions ranging from 3-5cm it was achieved in 13/16 [81%]. In group C, complete ablation was 100% [13/13] for lesions = 3cm and 93.3% [14/15] for lesions 3-5cm. Comparing the outcome of all techniques the overall success in group A was 71.4% while in group B it was 88.5% and 96.4% in group C. As regards the number of sessions in each group, the mean number of sessions was 2.2 +/- 0.75, 2.19 +/- 0.72 and 5.2 +/- 2.6 in group A, B and C, respectively. Major complications occurred in 4 patients of group A [second degree burn at the site of grounding pads, pneumothorax, malignant pleural effusion and hematemesis] and in one patient of group C [seedling]. Minor complications as pain, fever and ascites occurred in all groups, but it was more evident in group B. After the follow up of all patients the survival rate was 93 and 83% for group A, 85% and 78% for group B and 45.4%, 30% for group C patients at 1 year and 1.5 years, respectively. In conclusion, PEI, PAI and RFA are effective modalities for treatment of HCC; however PEI and PAI are cheaper, more effective and safer than RFA, however the survival was better in the RFA group