Prognostic significance of anatomical resection and des-γ-carboxy prothrombin in patients with hepatocellular carcinoma

Imamura, Hiroshi; Matsuyama, Yutaka; Miyagawa, Yusuke; Ishida, Kumiko; Shimada, Ryo; Miyagawa, Shinichi; Makuuchi, Masatoshi; Kawasaki, Seiji

doi:10.1046/j.1365-2168.1999.01185.x

Cited by 225 publications

(185 citation statements)

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“…These results are in accordance with previous reports [3,8,10,12,[15][16][17][18][19][34][35][36] . However, limiting this to small hepatocellular carcinoma, DCP alone is the independent prognostic factor for both tumor recurrence and patients' survival, while presence of microscopic vascular invasion is a prognostic factor in patients outside the criteria.…”

Section: Discussionsupporting

confidence: 83%

“…Many reports state high DCP levels to be of poor prognostic value. It has been shown that patients with high DCP and high AFP levels show poor prognostic factors [4,6,[10][11][12][14][15][16][17][18] . Thus, a prognostic staging system in which DCP has been incorporated is being suggested.…”

Section: Discussionmentioning

confidence: 99%

“…It is believed that the elevation of the serum DCP level correlates with the presence of vascular invasion or intrahepatic metastases [2][3][4][5][6][7][8] . Furthermore, DCP has been reported to be an independent prognostic factor for recurrence and survival after hepatic resection [4,[9][10][11][12][13] , liver transplantation [6,14] , ablation treatment [15][16][17] , and transarterial chemoembolization (TAE) treatment [18] . However, the rate of detectable serum DCP levels in patients with small hepatocellular carcinoma is low [19][20][21][22][23][24] .…”

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Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

Hakamada

Kimura²,

Miura³

et al. 2008

WJG

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tumor recurrence. Because many patients with a high preoperative DCP level develop extrahepatic recurrence, it is necessary to screen the whole body. INTRODUCTIONDes-gamma-carboxy prothrombin (DCP) is a tumor marker specific for hepatocellular carcinoma [1] . It is believed that the elevation of the serum DCP level correlates with the presence of vascular invasion or intrahepatic metastases [2][3][4][5][6][7][8] . Furthermore, DCP has been reported to be an independent prognostic factor for recurrence and survival after hepatic resection [4,[9][10][11][12][13] , liver transplantation [6,14] , ablation treatment [15][16][17] , and transarterial chemoembolization (TAE) treatment [18] . However, the rate of detectable serum DCP levels in patients with small hepatocellular carcinoma is low [19][20][21][22][23][24] . Although methods have been improved [25,26] , sensitivity is still at about 50% for most small cell carcinoma [27][28][29][30] . Thus, almost all reports on the biological nature of DCP and its prognostic value are based on analyses of patients with larger or more advanced tumors with various degrees of hepatic functional reserve. Reports on the relevance of preoperative DCP level as a prognostic marker in small hepatocellular carcinoma patients are rare.This study thus aimed analysing the predictive value of preoperative serum DCP level on tumor recurrence and prognosis, particularly in hepatocellular carcinoma patients who had undergone liver resection and who met the criteria for small hepatocellular carcinoma [31] , i.e. a single Abstract AIM: To clarify the effect of a high des-gamma-carboxy prothrombin (DCP) level on the invasiveness and prognosis of small hepatocellular carcinoma. METHODS:Among 142 consecutive patients with known DCP levels, who underwent hepatectomy because of hepatocellular carcinoma, 85 patients met the criteria for small hepatocellular carcinoma, i.e. one ≤ 5 cm sized single tumor or no more than three ≤ 3 cm sized tumors. RESULTS:The overall survival rate of the 142 patients was 92.1% for 1 year, 69.6% for 3 years, and 56.9% for 5 years. Multivariate analysis showed that microscopic vascular invasion (P = 0.03) and serum DCP ≥ 400 mAU/mL (P = 0.02) were independent prognostic factors. In the group of patients who met the criteria for small hepatocellular carcinoma, DCP ≥ 400 mAU/mL was found to be an independent prognostic factor for recurrence-free (P = 0.02) and overall survival (P = 0.0005). In patients who did not meet the criteria, the presence of vascular invasion was an independent factor for recurrence-free (P = 0.02) and overall survivals (P = 0.01). In 75% of patients with small hepatocellular carcinoma and high DCP levels, recurrence occurred extrahepatically. CONCLUSION:For small hepatocellular carcinoma, a high preoperative DCP level appears indicative for

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

Hakamada

Kimura²,

Miura³

et al. 2008

WJG

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“…DCP, also known as prothrombin induced by vitamin K absence-II (PIVKA-II), is an abnormal prothrombin protein that is present at higher levels in the serum of HCC patients. Since the report by Liebman et al [18], DCP has been recognized as not only a highly specific marker for HCC but also a predictor of prognosis of HCC patients [86,87]. AFP-L3 is a fucosylated variant of AFP that reacts with Lens culinaris agglutinin A and can differentiate an increase of AFP due to HCC from that due to benign liver disease [20,21,82].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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Background and aims The role of alphafetoprotein (AFP) in the diagnosis and surveillance of hepatocellular carcinoma (HCC) is getting smaller owing to the advances in imaging modalities. The aims of this study were to assess the diagnostic accuracy of tumor markers in small HCC and to find the optimal cutoff value of each tumor marker for efficient surveillance. Methods Studies in all languages were identified by searching MEDLINE from 1982 to 2002. Studies were included when they showed sensitivity and specificity for HCCs 5 cm or smaller and recruited only patients with chronic hepatitis or liver cirrhosis as control. We assessed diagnostic odds ratios (DORs) for the evaluation of diagnostic accuracy of tumor markers and positive likelihood ratios (LRs+) to find the optimal cutoff value. DORs and LRs+ were combined according to the random effect model. The summary receiver operating characteristics (ROC) curve was also assessed. Results Seventeen articles on three tumor markers-AFP, des-gamma-carboxyprothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)-were enrolled after full-text evaluation. AFP was inferior to DCP and AFP-L3 in both DOR (4.50 vs. 8.16 and 10.50) and area under the ROC curve (0.647 vs. 0.688 and 0.695). Optimal cutoff values that provide the best LR+ were 200 ng/ml for AFP, 40 mAU/ml for DCP, and 15% for AFP-L3. Conclusions Diagnostic accuracy of AFP in small HCC was substantially limited. Surveillance including other tumor markers with optimal cutoff value should be conducted to confirm the efficacy of the policy.

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“…Since the report by Liebman et al [171], DCP has been recognized as not only a highly specific marker for HCC but also a predictor of prognosis of HCC patients [172,173]. According to the systematic review, the sensitivity, specificity, and LR?…”

Section: Des-c-carboxyprothrombinmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Prognostic significance of anatomical resection and des-γ-carboxy prothrombin in patients with hepatocellular carcinoma

Abstract: Anatomical resection appeared to have a beneficial effect on recurrence-free survival after hepatectomy for HCC. DCP measurement was effective in predicting HCC recurrence and had the advantage that it can be assessed before operation.

Cited by 225 publications

References 32 publications

Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

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