Thesis Abstract

Abstract
Hepatocellular carcinoma (HCC) is 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 widely used biomarker in the surveillance and diagnosis of HCC. However, its role in predicting the risk of HCC development in patients with hepatitis has been a topic of debate. This study aimed to analyze the alpha-fetoprotein (AFP) levels in hepatitis patients and assess its utility as a predictive marker for the development of hepatocellular carcinoma (HCC). A total of 200 hepatitis patients were enrolled in the study, including individuals with chronic hepatitis B, chronic hepatitis C, and hepatitis of other etiologies. The AFP levels were measured in all patients at regular intervals over a period of 2 years. The results showed that AFP levels were significantly elevated in patients with chronic hepatitis B compared to those with chronic hepatitis C and other hepatitis etiologies. Furthermore, a subgroup analysis revealed that hepatitis B patients who later developed HCC had a progressive increase in AFP levels leading up to the diagnosis of cancer. In contrast, AFP levels remained relatively stable in hepatitis C patients who did not develop HCC during the study period. A receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic accuracy of AFP in predicting HCC development in hepatitis patients. The area under the curve (AUC) was found to be 0.85, indicating a good predictive performance of AFP in differentiating between hepatitis patients who were at high risk of developing HCC and those who were not. In conclusion, our findings suggest that monitoring AFP levels in hepatitis patients, particularly those with chronic hepatitis B, may aid in assessing the risk of HCC development. Regular surveillance of AFP could help in identifying high-risk patients who may benefit from closer monitoring or early intervention strategies. Further prospective studies are warranted to validate these results and establish the role of AFP as a prognostic marker in hepatitis patients at risk of HCC.

Thesis Overview

1.0 INTRODUCTIONHepato cellular 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 sub clinical 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).