Alzamzamy Ahmed, Elsayed Huda, Abd Elraouf Mona, Eltoukhy Hanan, Megahed Tarek, Aboubakr Ashraf
Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo 11841, Egypt.
Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo 11311, Egypt.
World J Gastrointest Oncol. 2021 Jun 15;13(6):600-611. doi: 10.4251/wjgo.v13.i6.600.
Hepatocellular carcinoma (HCC) accounts for 8.2% of all cancer-related deaths worldwide. Being a vascular tumor, vascular endothelial growth factor (VEGF) plays a vital role in HCC pathogenesis, growth, and spread.
To determine the accuracy of serum VEGF and VEGF/platelet (PLT) as tumor markers in the early detection of HCC cases in patients with hepatitis C virus (HCV)-related liver cirrhosis.
We conducted a case-control study with HCV patients from the outpatient and inpatient hepatology clinics. Patients were classified into three groups: (1) HCC group; (2) Cirrhosis group; and (3) HCV without cirrhosis (control group). Patients were clinically evaluated, and blood samples were drawn for the analysis; serum VEGF levels were measured by a specific VEGF human recombinant enzyme-linked immunosorbent assay kit. Data from the three study groups were compared by the one-way analysis of variance or Kruskal-Wallis test. Receivers operating characteristic curves were constructed to determine the optimal cut-off values of alpha fetoprotein (AFP), VEGF, and VEGF/PLT that provided the best diagnostic accuracy. The sensitivity and specificity at the optimal cut-off value of each biomarker were then calculated.
This study included one hundred patients (HCC, cirrhosis, and control groups: = 40, 30, 30, respectively). HCC patients had significantly higher serum VEGF and VEGF/PLT levels than the non-HCC groups ( = 0.001). Serum VEGF and VEGF/PLT showed significant positive correlations with and HCC tumor size, stage, vascular invasion, and Child-Pugh classification. Moreover, a VEGF cut-off the value of 250 pg/mL provided 80% sensitivity and 81.7% specificity for discriminating HCC patient from non-HCC patients. Similarly, the ratio of VEGF/PLT provided sensitivity and specificity of 77.5% and 80%, respectively which is higher than the accuracy provided by AFP. The combination of AFP, VEGF, and VEGF/PLT increases the accuracy of diagnosing HCC to > 95%.
In HCV patients, serum VEGF and VEGF/PLT separately or in combination with AFP are reliable biomarkers for early and accurate HCC diagnosis.
肝细胞癌（HCC）占全球所有癌症相关死亡人数的8.2%。作为一种血管肿瘤，血管内皮生长因子（VEGF）在HCC的发病机制、生长和扩散中起着至关重要的作用。
确定血清VEGF和VEGF/血小板（PLT）作为肿瘤标志物在丙型肝炎病毒（HCV）相关肝硬化患者早期检测HCC病例中的准确性。
我们对门诊和住院肝病科的HCV患者进行了一项病例对照研究。患者分为三组：（1）HCC组；（2）肝硬化组；（3）无肝硬化的HCV组（对照组）。对患者进行临床评估，并采集血样进行分析；血清VEGF水平通过特定的VEGF人重组酶联免疫吸附测定试剂盒进行测量。通过单因素方差分析或Kruskal-Wallis检验比较三个研究组的数据。构建受试者工作特征曲线以确定甲胎蛋白（AFP）、VEGF和VEGF/PLT的最佳临界值，这些临界值可提供最佳诊断准确性。然后计算每个生物标志物在最佳临界值时的敏感性和特异性。
本研究纳入了100名患者（HCC组、肝硬化组和对照组分别为40、30、30例）。HCC患者的血清VEGF和VEGF/PLT水平显著高于非HCC组（P = 0.001）。血清VEGF和VEGF/PLT与HCC肿瘤大小、分期、血管侵犯和Child-Pugh分级呈显著正相关。此外，VEGF临界值为250 pg/mL时，区分HCC患者与非HCC患者的敏感性为80%，特异性为81.7%。同样，VEGF/PLT比值的敏感性和特异性分别为77.5%和80%，高于AFP的准确性。AFP、VEGF和VEGF/PLT联合使用可将HCC诊断的准确性提高到>95%。
在HCV患者中，血清VEGF和VEGF/PLT单独或与AFP联合使用是早期准确诊断HCC的可靠生物标志物。
