Des-?-carboxy prothrombin as a useful predisposing factor for the development of portal venous invasion in patients with hepatocellular carcinoma

Abstract

BACKGROUND Portal venous invasion (PVI) in patients with hepatocellular carcinoma (HCC) is an important factor affecting prognosis. The objective of this study was to elucidate predisposing factors for the development of PVI. METHODS Two hundred twenty‐seven patients with HCC who did not show PVI and who received percutaneous ethanol injection therapy and/or microwave coagulation therapy at the time of their first hospital admission were enrolled between 1994 and 1996. After their HCC was treated, the patients were followed for a mean of 19 months. For the detection of HCC recurrence and/or development of PVI, ultrasonography was performed every 3 months, a computed tomography (CT) scan was performed every 6 months, and the biochemical parameters of the patients were measured every month. PVI was defined as protrusion of the tumor into the first and/or second branch or into the main trunk of the portal vein. RESULTS Of the 227 patients, 24 (11%) later developed PVI. Tabular analysis was performed on these 24 patients and indicated that tumor size, albumin, total bilirubin, prothrombin time, α‐fetoprotein (AFP) level, and des‐γ‐carboxy prothrombin (DCP) level differed significantly between the time of initial admission and the time of PVI development. A univariate analysis performed on the 227 patients indicated that an increase in the numbers of tumors, the histologic tumor grade (differentiation), the AFP level, and the DCP level at the time of initial diagnosis of HCC had a significant correlation with the later development of PVI; and a stepwise, multivariate Cox regression analysis revealed that the DCP level was the strongest predisposing factor (P < 0.0010; risk ratio = 5.65) followed by the histologic grade of tumor differentiation. CONCLUSIONS The results suggest that the serum DCP level is the most useful predisposing clinical parameter for the development of PVI. Cancer 2001;91:561–9. © 2001 American Cancer Society.

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

“…The pretreatment levels of these markers are useful predictors of local tumor progression. 33,34 However, their post-treatment levels have been considered to have limited efficacy as predictors of local tumor recurrence after TACE 35 and percutaneous ablation. 36 Elevated serum levels of alpha-fetoprotein, which reflect not only tumor-cell proliferation but also active disease with continuous necrosis and regeneration, are associated with an elevated risk of developing HCC.…”

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

“…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].…”

Treatment of hepatocellular carcinoma with major portal vein thrombosis by combined therapy with subcutaneous interferon-α and intra-arterial 5-fluorouracil; role of type 1 interferon receptor expression

“…Levy and Sherman (2002) reported that the CLIP classification for HCC is easier to implement and more accurate than the OKUDA classification. In addition, Koike et al (2001) suggested that serum PIVKA-II level is the most useful predisposing clinical parameter for the development of portal vein invasion. To investigate the role of these clinical parameters, AFP, PIVKA-II, OKUDA score, and CLIP score were used in the present study to assess the clinical effects of IFN-a/5-FU combination therapy.…”