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Laboratory investigations embolic material injected in all patients.
Five milliliter venous blood samples were collected
from patients and controls, centrifuged, the serum Follow-up of HCC patients
was separated and divided into two aliquots. The first Follow-up was conducted for a minimum of 1 year to
aliquot was used for routine laboratory investigations assess their survival and mortality rates.
including liver function tests (aspartate transaminase,
alanine transaminase, bilirubin, and albumin) using fully Statistical analysis
automated auto analyzer SYNCHRON CX9ALX (Beckman Statistically analysis was conducted using SPSS program
Coulter Inc., CA, USA). Serum AFP concentration was version 13 for windows (SPSS Inc., Chicago, Illinois,
measured using the Automated Chemiluminescence USA) and for all the analysis. A P < 0.05 was considered
System ACS: 180 provided by Siemens Medical Solutions statistically significant.
Diagnostics Corporation, USA. The second aliquot was
stored in the deep freezer (-70 °C) for detection of EGF. [15] RESULTS

Serum EGF enzyme-linked immunosorbent assay Most of our patients were males (92.1% male, 7.9% female
Estimation of serum EGF using Human EGF enzyme- in group I; 87.5% male, 12.5% female in group II; and 85%
linked immunosorbent assay (ELISA) kit (sandwich male, 15% female in group III). Mean age for groups I, II,
ELISA), Anogen, catalogue number EL10010 Mississauga, III, and IV was 58.2 ± 8.7 [standard deviation(SD)] years,
Ontario, Canada (up to 336 pg/mL) following 48.47 ± 11.51 years, 49.47 ± 6.94 years, and 47.50 ±
manufacturer’s protocol. 6.15 years, respectively, with statistically non-significant
difference (P > 0.05).
Radiological examination
Abdominal ultrasonography, triphsic computed Liver function tests in different patient groups are shown
tomography, and dynamic magnetic resonance imaging in Table 1. Child-Pugh score and BCLC staging for patients
was performed on patients when required. are shown in Tables 2 and 3, respectively.

TACE Radiological criteria of hepatocellular carcinoma
Chemoembolization was performed percutaneously at Twenty-three patients (45.1%) had a single focal lesion, 9
the angiography unit of the National Liver Institute with Table 1: Liver function tests in the three patient groups
the patient under conscious sedation. After infiltration Group I Group II Group III P
of local analgesic, the Seldinger technique was used (n = 51) (n = 40) (n = 40)
to gain access to the common femoral artery through Bilirubin 1.76 ± 1.2 0.83 ± 0.24 1.72 ± 1.59 < 0.05
femoral artery puncture. A 5-french vascular sheath was (mg/dL) 3.16 ± 0.65 4.35 ± 0.53 3.06 ± 0.84 < 0.05
Albumin
placed into the common femoral artery over a 0.035- (g/dL) 67.34 ± 38.4 61.80 ± 41.13 55.82 ± 30.17 0.31
ALT (U/L)
inch guide-wire. Under fluoroscopic guidance, a 5-french AST (U/L) 90.03 ± 55.8 48.55 ± 25.20 67.30 ± 32.03 < 0.05
14.04 ± 1.78
10.76 ± 2.31
11.53 ± 1.86
glide Cobra catheter (Cordis Corporation, Miami Lakes, Hb (g/dL) 114.58 ± 55.0 192.62 ± 47.9 104.37 ± 62.9 < 0.05
Platelet
< 0.05
Florida, USA) was advanced into the aorta. Angiographic (/mm )
3
study of the superior mesenteric artery, celiac trunk, and Data shown as mean ± SD. Group I: HCC patients; Group II: chronic
the common hepatic artery was performed to identify hepatitis; Group III: cirrhotic patients; ALT: alanine transferase; AST:
aspartate aminotransferase; Hb: hemoglobin; SD: standard deviation; HCC:
all of the vessels feeding the HCC nodule, and to assess hepatocellular carcinoma
patency of the portal vein. In some patients, selective Table 2: Study of CPS in groups I and II
angiography of the phrenic or intercostal arterial CPS (A) (%) CPS (B) (%) CPS (C) (%) P
branches was required. The arterial branches feeding the Group I 24 (47) 16 (31.3) 11 (21.7) < 0.05
14 (35)
Group II
7 (17.5)
19 (47.5)
tumor were selectively cannulated by microcatheters to CPS: Child-Pugh score; (A): score 5-6; (B): score 7-9; (C): score 10-15; Group
proceed with TACE and to ensure better preservation of I: HCC patients; Group II: chronic hepatitis; HCC: hepatocellular carcinoma
the surrounding non-tumoral liver tissue. Injection was Table 3: BCLC staging in HCC studied patients
done using an emulsion of lipiodol-doxorubicin (50 mg Groups BCLC (B) BCLC (C) BCLC (D) Total P
of doxorubicin mixed with 6-20 mL of lipiodol according (%) (%) (%)
to tumor size, number, and vascularity to form the Group Ia 18 (85.8) 3 (14.3) 0 21 < 0.05
0
emulsion); injection was performed far from the origin of Group Ib 18 13 (44) 17 (56) 30
16
17
Total
51
the gastroduodenal, right gastric, and cystic arteries; the Group Ia: HCC, underwent TACE; Group Ib: HCC, did not undergo TACE.
amount injected into the tumor was adjusted according BCLC: Barcelona-Clinic Liver Cancer; (B): intermediate stage; (C): advanced
stage; (D): end stage; HCC: hepatocellular carcinoma; TACE: transarterial
to the size and uptake of the tumor. Gel foam was the chemoembolization
20 Hepatoma Research | Volume 2 | Issue 1 | January 15, 2016