ABSTRACT
Pre-therapeutic serum levels of the angiogenic factors VEGF and bFGF were detected in sera of HCC patients, and were compared with the routinely used tumor marker used for diagnosis and follow up of HCC as AFP to evaluate the role of these angiogenic factors in diagnosis of HCC patients. The relation between the serum levels of VEGF, and bFGF and the clinical characteristics of HCC was also elucidated. This study was conducted on 50 patients with hepatocellular carcinoma. Diagnosis was confirmed by fine needle biopsy [FNB]. The study also included 9 patients with hepatitis C, 9 with hepatitis B, and 9 patients with cirrhosis, 11 healthy age and sex matching volunteers were included as controls. HCV patients were diagnosed by positive hepatitis C antibodies. HBV patients were diagnosed by positive hepatitis B surface antigens, while the cirrhotic patients by ultrasonography and positive bilharzial antibodies. All patients and control serum samples were tested for; vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF], alpha-fetoprotein [AFP]. Serum VEGF, bFGF and AFP levels were significantly elevated in HCC group. According to tumor size, only AFP showed statistically significant elevation [p 0.048]. bFGF was statistically significantly higher in cases with ascites than in those without ascites [p 0.003]. AFP and bFGF were statistically significantly higher in cases with edema than in those without edema [p 0.03 and 0.05, respectively]. Only AFP showed statistically significant elevation with portal vein thrombosis [p 0.03] and stage of the disease [p 0.002]. On measuring the sensitivity and specificity of the different tumor markers in HCC, VEGF showed the highest sensitivity [98%]. while AFP showed the highest specificity [100%]. The best diagnostic accuracy for double combinations was obtained with [AFP and VEGF], [AFP and VEGF/PLT ratio], [VEGF/PLT ratio and VEGF] and [bFGF and VEGF]. The best triple combination was detected between the combination. [VFGF. bFGF and VEGF/PLT ratio] and with the combination [AFP, bFGF.and VEGF] with diagnostic accuracy of 81.1%, and 80.7% . respectively. Elevated serum VEGF and bFGF levels were encountered n I-ICC compared to control groups. and serum VEGF has a higher sensitivity than other markers for the diagnosis of HCC Combined VEGF with AFP. bFGF. or VEGF/PLT ratio or with bFGF and VEGF/PLT ratio may he used to increase the overall diagnostic accuracy in HCC