The role of tumor markers in the diagnosis of hepatocellular carcinoma, with special reference to the des-gamma-carboxy prothrombin

Abstract

The assessment of new and more sensitive serum markers for hepatocellular carcinoma (HCC) represents a useful contribution to the diagnosis of small liver tumors, still amenable by surgery. We evaluated the efficacy of the tumor markers proposed during recent years for the study of HCC: alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), serum ferritin (SF), tissue polypeptide antigen (TPA), and, finally, the more recently proposed des-gamma-carboxy prothrombin (DCP). Of the 227 patients included in this retrospective study, 111 had HCC, and 85 of these were also cirrhotic. The remaining 116 patients, considered as the control group, included 23 patients with liver metastases from colorectal cancer, 26 with benign hepatic lesions, 20 with tumors other than HCC without hepatic metastases, and 47 with other liver diseases. For each single tumor marker, the sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and Younden index were assessed. AFP and DCP proved to be the most effective, with sensitivity, specificity, and diagnostic accuracy of 54.9%, 97.4%, and 76.6% and of 53.3%, 88.1%, and 71.1%, respectively. The same parameters evaluated for combined use of the two markers were 74.2%, 87.2%, and 80.9%, respectively. Analysis of the other markers produced no further significant contribution. Of the 111 patients with HCC, 35 (33.3%) were positive for both AFP and DCP, 43 (41%) were positive for one of them, and 27 (25.7%) were completely negative. In the 44 patients who underwent liver resection or transplantation, DCP correlated significantly with the histological presence of microvascular thrombosis, the major factor determining long-term survival after curative surgery. As a tumor marker for HCC, DCP is at least as effective as AFP; the combined use of AFP and DCP significantly improves the chances of identifying HCC by serodiagnosis.

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

“…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.…”

“…Shirabe et al [8] reported that the preoperative DCP level, tumor diameter, and histologic differentiation correlated with the presence or absence of microscopic vascular invasion in a study on 218 patients who had undergone hepatic resection. Sakon et al [2] , Suehiro et al [4] , Grazi et al [3] , Sugimoto et al [5] , and Nanashima et al [13] also reported that a high preoperative DCP level correlated with the presence of microscopic vascular invasion in patients undergoing hepatectomy. Shimada et al [6] reported in a study on 40 patients who had undergone a living donor liver transplantation DCP levels ≥ 300 mAU/mL to be correlated with the presence of microscopic vascular invasion and DCP thus to be a poor prognostic factor.…”

“…There are reports that a high DCP level correlates with invasiveness and the metastasizing property of carcinoma [2][3][4][5][6][7][8] . Shirabe et al [8] reported that the preoperative DCP level, tumor diameter, and histologic differentiation correlated with the presence or absence of microscopic vascular invasion in a study on 218 patients who had undergone hepatic resection.…”

“…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] .…”

758 Frequency of Elevated Biomarkers in Patients With Cryptogenic Hepatocellular Carcinoma

“…Several investigations have made comparisons of the usefulness of DCP and AFP for HCC diagnosis [37][38][39][40]. However, whether AFP is superior to DCP in all cases is still controversial.…”