Thesis Abstract

Abstract
Hepatocellular carcinoma (HCC) is a primary liver malignancy and one of the leading causes of cancer-related deaths worldwide. Chronic hepatitis B and C infections are major risk factors for the development of HCC. Alpha-fetoprotein (AFP) is a well-known biomarker that has been used for surveillance and monitoring of HCC in high-risk populations. However, its utility in predicting the progression from chronic hepatitis to HCC remains controversial. This study aimed to analyze the levels of alpha-fetoprotein in hepatitis patients and assess its role in predicting the development of HCC. A total of 200 patients with chronic hepatitis, 100 patients with HCC, and 50 healthy controls were included in the study. Serum samples were collected from all participants, and AFP levels were measured using enzyme-linked immunosorbent assay (ELISA). The results showed that AFP levels were significantly higher in patients with HCC compared to those with chronic hepatitis and healthy controls (p < 0.05). Among patients with chronic hepatitis, those who later developed HCC had higher baseline AFP levels than those who did not develop HCC. Furthermore, AFP levels were positively correlated with the stage and severity of liver disease in both chronic hepatitis and HCC patients. Receiver operating characteristic (ROC) curve analysis revealed that AFP had good diagnostic accuracy in differentiating HCC from chronic hepatitis, with an area under the curve of 0.85. Using a cutoff value of 200 ng/mL, AFP had a sensitivity of 75% and a specificity of 80% in predicting the development of HCC in patients with chronic hepatitis. In conclusion, our findings suggest that alpha-fetoprotein levels can serve as a useful biomarker for predicting the progression from chronic hepatitis to HCC. Monitoring AFP levels in hepatitis patients, especially those with high-risk factors such as cirrhosis, may help in early detection and intervention for HCC. Further prospective studies with larger sample sizes are needed to validate the utility of AFP as a predictive marker for HCC development in hepatitis patients.

Thesis Overview

1.0 INTRODUCTION

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. It accounts for 60% of all cancer world wide (Melissa 2004). The most significance cause is the presence of cirrhosis. HCC has unique geographic sex, age distribution that are likely determined by specific actiology factor. It’s distribution also varies among ethnic group within the same country (Munoz 1989). A high incidence of hepatitis B and C may have been an important factor contributing to the development of liver disease (HCC and Cirrhosis) in south eastern Nigeria. However, a recent trend which reveals an increase in cases of liver cirrhosis and hepatitis in our environment suggest that there could be other contributory factors peculiar to our environment besides hepatitis B and C which could be possible explanation to the recent trend. In so doing, it would be necessary to look into the various predisposing/causative factors of chronic hepatitis which could lead to increased cases of liver cirrhosis and HCC in our environment. The risk of developing HCC differs depending on the cause of cirrhosis. For example, cirrhosis due to hepatitis B has a high risk of leading to HCC while the risk of HCC in people with primary biliary cirrhosis, although present is very low. All these human hepatitis viruses are RNA viruses except for hepatitis B virus, which is a DNA virus. Although these viruses can be distinguished by their molecular and antigenic properties, all types of viral hepatitis produce clinically similar illnesses. These range from asymptomatic and unapparent to fulminant and fatal acute infections common to all types, on one hand, and from subclinical persistent infections to rapidly progressive liver disease with cirrhosis and even hepatocellular carcinoma (HCC), common to the blood-borne types (HBV and HCV). Without specific virological test, it is not possible to determine which hepatitis virus is responsible for a case of hepatitis. (Kathleen park et al., 2004).