Combining des-gamma-carboxyprothrombin and alpha-fetoprotein for hepatocellular carcinoma diagnosing: an update meta-analysis and validation study

Abstract

Controversies about the combination of des-gamma-carboxyprothrombin (DCP) and alpha-fetoprotein (AFP) for hepatocellular carcinoma diagnosing still exist. Hence, we performed this updated meta-analysis to estimate the diagnostic value of DCP , AFP and DCP + AFP in HCC. In addition, we conducted a validation study to analyze the performance of the candidate makers. After a systematic literature review, 27 studies from 20 articles were identified from four major databases. The pooled sensitivity and specificity were 69% and 89%, respectively, for DCP; for AFP, they were 65% and 88%, respectively; and they were 82% and 85%, respectively, for DCP + AFP. The values of the area under the curve (AUC) for DCP, AFP, DCP + AFP, respectively, were 0.88, 0.75, and 0.90. The validation study confirmed that the performance of DCP + AFP (sensitivity = 84%, specificity = 86%; AUC = 0.887) was higher than that of DCP (sensitivity = 76%, specificity = 92%; AUC = 0.843) or AFP (sensitivity = 73%, specificity = 92%; AUC = 0.837) alone.

Hepatocellular Carcinomas With Mutational Activation of Beta-Catenin Require Choline and Can Be Detected by Positron Emission Tomography

“…However the afetoprotein assay has a low sensitivity (60%) and is not specific for the identification of altered signaling pathways. 1,2 Imaging methods have emerged for the monitoring of high-risk patients. The 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) and its hybrid version associating computed tomography (PET/CT) have the clinical utility to detect many cancers, but are limited in HCC by low sensitivity (60% overall).…”

Soluble Axl Is a Novel Diagnostic Biomarker of Hepatocellular Carcinoma in Chinese Patients with Chronic Hepatitis B Virus Infection

“…Measurement of serum α-fetoprotein (AFP) levels is the gold standard for high-risk patients to detect HCC at an early stage [ 4 ]. However, due to its low diagnostic accuracy with sensitivities ranging from 25%-65% and a specificity 74%-94%, it is less than satisfactory as a widely used biomarker in the clinic [ 5 , 6 ]. Several new candidate biomarkers have been proposed to complement AFP and increased the accuracy of HCC detection, such as lectin-bound AFP (AFP-L3%), des-γ-carboxyprothrombin, glypican3, Golgi protein-73, and Dickkopf-1.…”

“…Several new candidate biomarkers have been proposed to complement AFP and increased the accuracy of HCC detection, such as lectin-bound AFP (AFP-L3%), des-γ-carboxyprothrombin, glypican3, Golgi protein-73, and Dickkopf-1. However, diagnostic values of all have controversial that limited clinical usefulness [ 6 - 9 ]. Thus, further research is necessary and urgent to identify additional novel candidates.…”

Next-generation des-r-carboxy prothrombin for immunohistochemical assessment of vascular invasion by hepatocellular carcinoma

“…Des-r-carboxy prothrombin (DCP), known as proteininduced vitamin K absence or antagonist-II (PIVKA-II), is a biomarker for hepatocellular carcinoma (HCC) offering sensitivity of 40-56% and specificity of 81-98% [1][2][3][4][5][6]. The serum DCP level is considered more specific than alpha-fetoprotein (AFP) for malignant potential in HCC, but the diagnostic powers of the two markers do not overlap [6][7][8]. Conventional DCP has not become a commonly used marker because the value is not accurate in the presence of vitamin K deficiency, the use of anticoagulants, or poor nutritional status associated with alcoholic abuse or jaundice [9][10][11][12].…”

“…Des-r-carboxy prothrombin (DCP), known as protein-induced vitamin K absence or antagonist-II (PIVKA-II), is a biomarker for hepatocellular carcinoma (HCC) offering sensitivity of 40–56% and specificity of 81–98% [ 1 – 6 ]. The serum DCP level is considered more specific than alpha-fetoprotein (AFP) for malignant potential in HCC, but the diagnostic powers of the two markers do not overlap [ 6 – 8 ].…”