The Diagnostic Value of Serum Vascular Endothelial Growth Factor as a Predictor of Hepatocellular Carcinoma in Patients with HCV related Liver Cirrhosis

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. Tumor markers are substances synthesized and secreted by the malignant cells and they are not normally found and they are not biologically active if present as they present in much smaller amounts, few of them are produced in a sufficient large proportions, so they can be used as serum markers of tumors and they become helpful in screening, diagnosis and follow up of cases. 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. In addition, VEGF causes vasodilatation, partly through stimulation of nitric oxide synthase in endothelial cells. VEGF can also stimulate cell migration and inhibit apoptosis. 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. The study included 105 subjects divided into three groups: group I was 35 patients with hepatocellular carcinomas group II was 35 patients with HCV related liver cirrhosis and group III was35 normal subjects serving as control group. The plasma VEGF level was significantly higher in group I patients (with HCC), than in the group II patients and control group. VEGF showed direct significant correlation with liver enzymes (AST and ALT levels), INR and plt. This study showed that VEGF levels in the HCC group were affected by number of the tumor and overall size. The sensitivity and specificity of VEGF for selective detection of the HCC group over cirrhotic group, was 82.9% and 80% respectively at a cut off value of 210. The sensitivity and specificity of AFP for selective detection of the HCC group over cirrhotic group, was 77.1% and 82.9% respectively at a cut off value of 6.3. So plasma vascular endothelial growth factor level appears to be additional marker for HCC detection.