Summary
Liver cancer, predominantly hepatocellular carcinoma (HCC) arising in the context of cirrhosis, is the second most lethal cancer worldwide with persistently increasing mortality in Europe, North/South America, and Africa in contrast to the decreasing trend in East Asia.
Egypt has a high incidence of HCC about 21% in cirrhotic Egyptian patients.
Cirrhosis and HCC are the major life-limiting consequences of progressive fibrotic liver diseases, mainly caused by hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol abuse, and non-alcoholic fatty liver disease (NAFLD).
HCC given its asymptomatic nature in the early stages of the disease, the majority of cases are detected in advanced stages, leading to incurable disease states.
Recently, several studies that use molecular signatures have provided another promising strategy for the prediction of HCC prognosis.
Multiple studies have been focused on the relation between HCC and serum level of TGF-β1 , its gene expression and polymorphism .
Most of the studies focused on two polymorphisms: +869C/T (rs1800470) and −509C/T (rs1800469). However, the associations observed between two polymorphisms and the risk for HCC were controversial and inconclusive.
This study aims to evaluate the role of serum level of Transforming growth factor - β1 , its gene expression in peripheral blood and its polymorphism (rs1800469) in diagnosis of HCC in chronically infected Egyptian HCV patients.
In order to achieve this goal, thirty five patients confirmed to have HCC, thirty patients with liver cirrhosis without HCC and twenty control subjects were selected from Hepatology, Gastroenterology and Infectious Diseases Department in Benha University Hospital in period from February 2018 to October 2018. The protocol of this study was approved by the Ethical Committee of the Faculty of Medicine, Benha University.
All patients included in the study were subjected to full history taking , clinical examination, routine laboratory and radiological investigations. Additionally, serum level of Transforming growth factor - β1 , its gene expression in peripheral blood and its polymorphism (rs1800469) were done.
This study revealed that, HCC was presented more in males with male to female ratio 1.33:1 and the mean age of patients with HCC was (62.0±8.7) years, ranging from (45-80) years. There was no statistically significant difference between the studied groups regarding age and sex.
Loss of weight, ascites and jaundice were the commonest as regard medical history concerning cirrhotic with HCC group .
According to laboratory investigations, the value of platelet count, serum creatinine, serum blood urea, ESR, serum albumin, INR and AFP were significantly higher in cirrhotic with HCC group rather than other groups.
Concerning Child classifications, the majority of cirrhotic with HCC group were Child class B (60%) followed by Child class C (28.6%) and (11.4%) of patients were Child class A. As regard OKAUDA staging of HCC patients the majority of patients were stages III ( 45.7 % ) , followed by stage II ( 42.9 % ) and stage I (11.4).
Abdominal ultrasonography to cirrhotic with HCC group showed that multiple hepatic focal lesion were in (54.3%) of patients, right lobe focal lesions were in (57.1) and hypoechoic lesions were in (51.4) of them.
Concerning serum level of TGF-β1, there was highly statistically significant difference between the three studied groups.
As regarding Gene expression, there was highly statistically significant difference between the three studied groups.
But concerning TGF-β1 polymorphism, there was no statistically significant difference between the three groups and the most frequent genotyping in cirrhotic with HCC group were CT ( 57.1%) followed by TT genotype (22.9%) and CC genotype (20%).
Factors possibly associated with the development of cirrhotic with HCC group were assessed by univariant regression analysis compared with non HCC groups. These factors included Age > 58 years, Loss of weight, history of abdominal pain, history of hepatic encephalopathy, creatinine level > 1.3 (mg/dl), serum albumin level < 2.5 (mg/dl), ESR > 80, AFP ≥ 41(ng/ml), TGF ≥ 733.9 (pg/ml) and level of gene expression ≥ 1.85 were significant predictors of HCV - related HCC.
|
