Study of Serum Vascular Endothelial Growth Factor Versus Alpha Fetoprotein In HCV Cirrhotic Patients with Hepatocellular Carcinoma (HCC) Before and after Therapeutic Intervention

Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and it is one of the major causes of death, because of its high frequency and poor prognosis. Hepatocellular carcinoma is now a rather common malignancy in Egypt which usually develops on top of liver cirrhosis secondary to viral infection, as hepatitis C viruses increased the risk of HCC in the Egyptian patients. Early diagnosis of HCC can improve the prognosis of HCC patients. Many research groups are evaluating the sensitivity of available tumor markers and also are investigating the development of novel markers. The primary marker for HCC is alpha fetoprotein (AFP), a single polypeptide chain glycoprotein. Generally, AFP shows acceptable sensitivity; however, AFP is not secreted in all cases of HCC and may be normal in as many as 40% of patients with early HCC (Nakatsura et al. 2003). In addition, the serum AFP level does not always correspond to the clinical stage of HCC (Nakagawa et al., 1999). Thus, AFP appears to have limited utility as a screening test (Bruix and Sherman, 2005). Vascular endothelial growth factor (VEGF) is a heparin-binding glycoprotein that is secreted from endothelial cells. Platelets release VEGF upon aggregation and may be a major source of VEGF delivery to tumors.Many tumors release cytokines that can stimulate the production of megakaryocytes in the marrow and elevate the platelet count. This can result in an indirect increase of VEGF delivery to tumors. Serum vascular endothelial growth factor (VEGF) levels in HCC patients were significantly higher, compared to control individuals, and was correlated with venous invasion and advanced tumor stage. They concluded that the expression of VEGF in HCC tissues was correlated with AFP (Amaoka et al.,2007). The aim of this study is to verify the possibility of using the plasma vascular endothelial growth factor level as a tumor marker for hepatocellular carcinoma and to evaluate its prognostic value in management of HCC The study included 80 subjects divided into three groups: group I was 40 patients with hepatocellular carcinomas group II was 20 patients with HCV related liver cirrhosis and group III was 20 normal subjects s