الفهرس 
HCCOnly 14 pages are availabe for public view
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Abstract
H
epatocellular carcinoma (HCC) represents a challenging malignancy of worldwide importance and is the second most common cause of cancer-related death globally. Although overall survival has improved in recent years, prognosis is still poor for patients with advanced disease.
In HCC patients, blood is at a hypercoagulative state, which is an important condition for promoting the growth and metastasis of tumors. An important sign for the hypercoagulative and hyperfibrinolytic state in HCC patients is the plasma D-dimer level. D-dimer is a universally available, routinely measured molecular marker which has the advantages of simplicity, rapidity, high sensitivity and reproducibility.
Ablative therapies have become the first-line treatment, as recommended by society guidelines for non-surgical patients with very early HCC achieving curative outcomes, while transarterial embolization techniques offer major benefit for patients with intermediate HCC.
D–dimer plays a certain role in assessing/predicting locoregional treatment efficacy and prognosis. Elevated D-dimer levels pre and post locoregional treatment in patients with HCC, may serve as simple but effective predictors of adverse tumor profile and outcome which could be used as a prognostic biomarker for such patients.
Positive post-TACE d-dimer is an unfavorable factor for HCC patients. The superior results obtained in cases undergoing RFA with patients having negative pretreatment D -dimer could be due to excellent local tumor control after application in a small tumour size and/or tumor biology in the study group.
To sum, elevated D-dimer levels, in HCC, may serve as simple but effective predictors of adverse tumor profiles and outcomes.
CONCLUSION
I
n conclusion, this study characterizes the pattern of D-dimer levels pre and post locoregional treatment during HCC treatment in cirrhotic patients. Pretreatment elevation of plasma D-dimer levels in HCC could serve as simple but effective biological predictors of adverse tumor profiles and disease prognosis. Progressive increase of D-dimer after locoregional treatment could be an independent risk factor for monitoring of adverse tumor outcome and poor survival in such patients.
RECOMMENDATIONS
W
e recommended to perform furthers studies on large sample sizes to improve the statistical power for subgroup analysis.
Results of the study will be help to suggest more accurate selection of patients from different (not single) medical centers in further studies . It is also recommended to prolong the study period in order to accurately analyze the relation between PFS and the changes of D-dimer after locoregional treatment.
Further research is needed for the generalizability of our finding. A longitudinal design and an interventional study with a large sample may help determine the optimal strategies to improve the utilization of D-dimer levels in HCC patients.