Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in american patients

Abstract

Mortality due to hepatocellular carcinoma (HCC) has not improved over the last 20 years. This is in part due to the poor performance of available tumor markers leading to delays in diagnosis. Des-gamma carboxy-prothrombin (DCP) has been reported to be more sensitive and specific for the diagnosis of HCC in Japanese patients compared with ␣-fetoprotein (AFP). We conducted a cross-sectional case control study to evaluate whether DCP is more sensitive and specific than AFP for differentiating HCC from nonmalignant liver disease in a cohort of American patients from a single referral center. Four groups were studied: G1, normal healthy subjects; G2, patients with noncirrhotic chronic hepatitis; G3, patients with compensated cirrhosis; and G4, patients with histologically proven HCC. A total of 207 subjects were enrolled. Both DCP and AFP levels increased progressively from G1 to G4, but DCP values had less overlap among the groups than AFP. ROC curve indicated that a DCP value of 125 mAU/mL yielded the best sensitivity (89%; 95% CI, 77%-95%) and specificity (95%; 95% CI, 82%-96%) for differentiating patients with HCC from those with cirrhosis and chronic hepatitis. The optimal AFP cutoff value was 11 ng/mL and was inferior to the DCP value of 125 mAU/mL, the area under the ROC curves being 0.928 versus 0.810, respectively (P ‫؍‬ .002). In conclusion, DCP was more sensitive and specific than AFP for differentiating HCC from nonmalignant chronic liver disease. Prospective studies to evaluate the role of DCP in early HCC are underway. (HEPATOLOGY 2003;37:1114-1121 T he incidence of hepatocellular carcinoma (HCC) is increasing in the United States. 1 However, patient survival in HCC has improved minimally over the last 2 decades. Between 1981 and 1998, the 5-year survival rate only rose from 2% to 5%. 2 The poor survival rate is in part related to the diagnosis of HCC at advanced stages where effective therapies are lacking. [3][4][5] Surveillance of patients at the highest risk for developing HCC, i.e., patients with cirrhosis, is an important strategy that can potentially decrease the cancer-related mortality rate. Although HCC meets the criteria of a tumor that would benefit from a surveillance program, 6 the poor sensitivity and specificity of currently available tools has prevented widespread implementation of HCC surveillance. For example, ␣-fetoprotein (AFP) has been the serum marker that is most widely used for diagnosis as well as surveillance of HCC. 7,8 However, AFP levels may be normal in up to 40% of patients with HCC, particularly during the early stages (low sensitivity). 9 Furthermore, elevated AFP levels may be seen in patients with cirrhosis or exacerbations of chronic hepatitis (low specificity). 10 Prospective studies evaluating the performance characteristics of AFP for HCC surveillance reported sensitivities of 39% to 64%, specificities of 76% to 91%, and positive predictive values of 9% to 32%. [11][12][13] Abdominal ultrasound is the most common imaging modality used in the surveillance of HCC. T...

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

“…For the development of APASL consensus statement for HCC, we performed additional systematic review of studies published from 2003 to August 2008. Summary of recent studies that met the inclusion criteria is shown in Table 1 [160][161][162][163][164][165][166][167][168][169]. The results of the studies that evaluated AFP, DCP, and AFP-L3 were grossly compatible with the previous review.…”

Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort

“…For all patients, demographic information, etiology of liver disease as previously defined, 16 biochemical data, hematological data, assessment of hepatic function based on Child-Turcotte-Pugh(CTP) and model for end-stage liver disease (MELD) score, and performance status were recorded. All data, including staging of the tumors, were determined at the time of HCC diagnosis and before therapy.…”

Serologic Autoantibodies as Diagnostic Cancer Biomarkers—A Review

“…With regards to these levels, the group confirmed the low sensitivity of AFP as 54% and did not recommend this marker for utilization in the routine diagnosis of hepatocellular carcinoma (109). Serum levels of des-g-carboxyprothrombin (DCP), another potential biomarker for hepatocellular carcinoma diagnosis, have been compared with AFP levels in an ELISA-based experiment performed by Marrero and colleagues (111). This research tested sera from 48 healthy controls, 51 patients with noncirrhotic hepatitis, 53 patients with compensated cirrhosis, and 55 patients with hepatocellular carcinoma against DCP and AFP individually and in combination to find the best marker or panel to differentiate patients with hepatocellular carcinoma from other patients with nonmalignant chronic liver disease.…”