Vascular Endothelial Growth Factor Level as A Predictor of Hepatocellular Carcinoma in Liver Cirrhosis Patients

BACKGROUND: Alpha-fetoprotein (AFP) has been used for hepatocellular carcinoma (HCC) diagnosis and screening, however, AFP has poor specificity. The extensive hypervascularity associated with HCC could be driven in part by the pro-angiogenic factor known as vascular endothelial growth factor (VEGF). Furthermore, invasiveness of certain HCC lesions has recently been linked to high levels of VEGF. Therefore, circulating VEGF levels of patients with liver cirrhosis (LC) and HCC were investigated and analysed.METHODS: An analytical cross sectional study was designed. Diagnosis of HCC and LC was performed using clinical criteria and findings obtained from B-mode ultrasonography (USG), computed tomography (CT) angiography, or magnetic resonance imaging (MRI). Blood were collected intravenously from all subjects. Obtained serum and plasma were stored in -80°C for following analyses: hepatitis B surface antigen (HBSAg), hepatitis C virus (HCV), alanine aminotransferase (ALT), total bilirubin, albumin, VEGF and AFP.RESULTS: Levels of VEGF and AFP were significantly higher in HCC group compared with LC group with p = 3.05 x 10-6 and p = 8.74 x 10-5, respectively. There was a significant positive correlation (p=0.029, r=0.309) between VEGF level and tumor size in HCC group. The area under curve (AUC) for VEGF level in HCC and LC groups was 0.771. In the level of median 435.6 pg/mL VEGF, the sensitivity was 50% and specificity was 86%. In the level of 199.99 pg/mL VEGF the sensitivity was 74% and specificity was 76%.CONCLUSION: The present findings suggested that VEGF level could be a useful marker for the presence of HCC in patients with LC.KEYWORDS: hepatocellular carcinoma, HCC, liver cirrhosis, LC, vascular endothelial growth factor, VEGF, alpha-fetoprotein, AFP

LABORATORIUM KLINIK PELUANG DAN TANTANGANNYA SUATU TINJAUAN DARI SEGI MANAJEMEN

Keberhasilan atau bahkan kelangsungan hidup suatu organisasi pelayanan kesehatan tergantung dari kemampuan organisasi tersebut dalam meningkatkan kualitas pelayanan dan produktivitasnya. Peningkatan kualitas dan produktivitas ini hanya dapat dicapai melalui peningkatan manajemen. Dalam membenahi struktur dan manajemennya, Laboratorium/Instalasi Patologi Klinik berpedoman pada konsep dari Mc. Kinsey dalam upaya menuju sukses. Konsep ini dikenal sebagai McKinsey 7-S Framework yang terdapat dalam buku In Search of Excellence karangan Thomas J. Peter & Robert H. Waterman Jr. Dalam konsep tersebut Mc-Kinsey menguraikan unsur-unsur penting yang menjadi inti konsep. Agar konsep ini mudah diingat, Anthony Athos dari Harvard Business School menganjurkan agar dari ketujuh unsur tersebut dibentuk suatu framework