EVALUATION OF THYROID BINDING GLOBULIN AS A TUMOR MARKER IN HEPATOCELLULAR CARCINOMA IN COMPARISON WITH ALPHA-FETOPROTEIN
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The diagnosis of hepatocellular carcinoma (HCC) is very vital. The aim of this study is to evaluate the role of thyroid binding globulin (TBG) as a tumor marker in Egyptian hepatocellular carcinoma in comparison with alpha-fetoprotein (AFP). Twenty patients with cirrhosis were taken as a cirrhotic control, 20 normal individuals as normal control, in addition to 30 hepatocellular carcinoma patients. We concluded that cirrhosis was found in 86.7% of the patients with hepatocellular carcinoma. Bilharziasis was confirmed in 40% of patients with hepatocellular carcinoma.There was a significant difference in TBG serum activity levels between the normal and the cirrhotic controls (P = 0.0003). Also, there was a significant difference between AFP levels in the cirrhotic group against that of the normal group (P = 0.0000004). In the HCC group , TBG serum activity levels were highly significant when compared with values in the normal group and significant in the cirrhotic group (P = 0.00012 and 0.011388, respectively).On the other hand , there was a highly significant difference between values of AFP in the HCC group and either of the normal and cirrhotic group (P = 0.009 and 0.00139 , respectively). At the mean + 2 SD cutoff value of the normal control group (33.33 p g /m1) , TBG had a sensitivity of 70% which is greater than the corresponding values of AFP at the widely accepted cutoff value of 500 mg / ml (sensitivity 53.3%). However , at the same cutoff values , TGB has less specificity. As regards the relation between TBG and the tumor size, TBG was above the cutoff value in 6 patients out of 12 (50%), in contrast to AFP which was above the cutoff value in only 2 patients (16.7%). TBG and AFP, measured together could detect 23 cases out of 30 patients with HCC with a sensitivity rate of 76.7% instead of 53.3% and 36.7% for AFP alone at a cutoff value of 500 and 523 ng/ml respectively and instead of 70% for TBG at a cutoff value of 33.33 p.g/ml. This leads to the suggestion of the simultaneous use of both TBG and AFP for early and better detection of hepatocellular carcinoma.