THE VALUE OF MEASUREMENT OF SERUM P53 ANTIBODY VERSUS ALPHA FETOPROTEIN IN THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA IN EGYPTIAN PATIENTS WITH LIVER CIRRHOSIS

Abstract

Summary H epatocellular carcinoma is one of the most common malignancies worldwide and the most common primary malignant tumor of the liver. It is the second leading cause of cancer related deaths in the world. It occurs most commonly on top of a cirrhotic liver which in Egypt is prevalence is due to chronic HCV infection. When patients with obvious clinical symptoms come to the hospital for treatment, the HCC has already reached the mild to advanced stages and is usually large in size. Given the subsequent rapid growth and vascular invasion, the prognosis then is very poor. Diagnosis of HCC at earlier stages, thus improves patient outcomes. Currently, the most commonly used methods for screening and diagnosing HCC are ultrasound imaging and serum α-fetoprotein (AFP) concentration measurements, but the diagnostic value of AFP is recently challenged due to its low sensitivity and specificity. The aim of this study was to determine the diagnostic value of p53 antibody as a biomarker for HCC in patients with HCV related liver cirrhosis. The study was conducted upon 90 subjects who were divided into three groups: group I included 35 patients with liver cirrhosis and hepatocellular carcinoma , group II included 35 patients with HCV related liver cirrhosis without HCC, group III had 20 healthy subjects as controls. In this study the age of patients in group 1 was higher than the other two groups with significant difference. Male: Female ratio was high in all the 3 groups. Non-smokers were more than smokers but with no significant difference. The Child-Pugh score was seen higher in the HCC group than the cirrhotic group, similarly was the MELD score. Regarding alpha fetoprotein its serum levels were much higher in the HCC group compared to the other two with significant difference. However, it did not increase significantly with tumour size, number, vascular invasion or BCLC classification. In this study, the serum levels of p53 antibody were highest in patients of group I with HCC compared to those with liver cirrhosis and the control groups with significant difference. Also p53 antibody values increased with tumor number and over all size but not with vascular invasion nor BCLC. At a cut off value 37, the diagnostic sensitivity and specificity of AFP for selective detection of HCC over the cirrhotic group was 54.3% and 100%. At a cut off value 0.42 the diagnostic sensitivity and specificity of p53 antibody for selective detection of HCC over the cirrhotic group was 74.3% and 97.1% respectively. When combining both markers together the sensitivity increased to 81% with a specificity of 100%. In conclusion, p53 antibody can be used as a biomarker for hepatocellular carcinoma with a good diagnostic and prognostic value.