Molecular Detection of Human Telomerase m-RNA(hTERT-mRNA) in Egyptian Patients with Hepatoellular Carcinoma

Background and aims: diagnostic modalities for hepatocellular carcinoma (hcc) as markers, sonography, and ct have contributed to the early detection of hcc but are still not sensitive enough. human telomerase rna subunit (htert-mrna) has been identified in many cancers and claimed to be reactivated in hcc. to investigate htert-mrna in the peripheral blood of hcc and chronic liver disease (cld) patients and correlate its level with alpha feto protein (afp), the serological marker for hcc..methods: the study was conducted on 44 patients selected from the national liver institute. patients included group i (22 patients diagnosed to have hcc), group ii (22 patients with cld), and 12 apparently healthy volunteers as controls (group iii). all selected individuals were subjected to history taking, a clinical examination, abdominal sonography and laboratory investigations as liver function tests (lfts), cell blood count (cbc), hepatitis viral markers, afp, and real-time polymerase chain reaction (pcr) quantitative detection of -mrna expression, encoding for telomerase catalytic subunit..results: there was a significant elevation of afp levels in the hcc group compared to both the cld and control groups (p < 0.00, p < 0.001). the mean htert-mrna expression in hcc patients was significantly higher than both cld patients and controls (p < 0.001, p < 0.001). htert-mrna was correlated with afp and tumor size (p < 0.05, p < 0.001). the afp cutoff level (185 ng/ml) resulted in a 63.6% sensitivity, a 85.3% specificity; a 89.3% positive predictive value (ppv) level, a 76.2 % negative predictive value (npv) level and a 83.4% accuracy for hcc prediction. the htert-mrna cutoff level (112.5 copies/ml) showed a 77.3% sensitivity, a 97.1% specificity, a 98% ppv level, a 79.2 % npv level, and an accuracy of 84% for hcc prediction. combining htert-mrna and afp increased diagnostic accuracy to 90.5%. both markers had a 84.1% sensitivity, a 86.4% specificity, a 86.4% ppv level, and a 88.3 % npv level..conclusions: htert-mrna is thought to be superior to afp in cld patients and could be a marker for the early diagnosis of hcc. combined htert-mrna and afp would augment early detection and successful follow-up of hcc patients.