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

Abstract

Background We have previously shown the value of next-generation des-r-carboxy prothrombin (NX-DCP) for predicting vascular invasion in hepatocellular carcinoma (HCC). Since conventional DCP is inaccurate under some conditions, this study aimed to assess whether NX-DCP immunohistochemical staining was related to vascular invasion in HCC. Methods Fifty-six patients scheduled to undergo resection for single HCC were divided into two groups, with and without pathological portal vein invasion. Immunohistochemical features of HCC and sites of vascular invasion were assessed using alpha-fetoprotein (AFP), conventional DCP, and NX-DCP. Results Pathological portal vein invasion was absent in 43 patients and present in 13 patients. Patient characteristics, pathological background of the liver parenchyma, and tumor-related factors did not differ significantly between the groups. There was no significant difference in the serum AFP level between the groups, whereas levels of conventional DCP (p < 0.0001) and NX-DCP (p < 0.0001) were significantly higher in the vascular invasion group. Immunohistochemical staining showed no significant difference in the staining rate of tumor (67.9% vs. 80.7%, p = 0.08), but NX-DCP stained significantly more at the sites of vascular invasion (15.4% vs. 46.2%, p = 0.01) than conventional DCP. No vascular invasion was stained by AFP. Conclusions NX-DCP offers better sensitivity for detecting sites of vascular invasion than AFP and conventional DCP.

Relationships Between Indices of Tumor Aggressiveness in Hepatocellular Carcinoma

“…There is only limited understanding of the mechanisms for PVT. However, there are increased reports for some of the factors that may be involved, such as blood des-gammacarboxy prothrombin or inflammatory processes [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46].…”

Protein induced by vitamin-K absence II: Another key to create a common language

“…Of note, despite PIVKA-II being a highly specific biomarker of HCC, it has not been widely accepted because its level is inaccurate in patients on warfarin or with poor nutritional status, such as alcoholic liver disease and jaundice, leading to vitamin K deficiency. [6] Unfortunately, most of the publications including the study by Lai and colleagues did not document standardized PIVKA-II measurement for detecting HCC; next-generation des-gammacarboxy prothrombin may prove to be a solution. [6] Besides PIVKA-II, there are many other biological markers that have been reported to be useful in predicting outcomes after LT, such as AFP-L3, [3] neutrophilto-lymphocyte ratio, [7] and lymphocyte-to-monocyte ratio.…”

“…[6] Unfortunately, most of the publications including the study by Lai and colleagues did not document standardized PIVKA-II measurement for detecting HCC; next-generation des-gammacarboxy prothrombin may prove to be a solution. [6] Besides PIVKA-II, there are many other biological markers that have been reported to be useful in predicting outcomes after LT, such as AFP-L3, [3] neutrophilto-lymphocyte ratio, [7] and lymphocyte-to-monocyte ratio. [8] In addition, 18 F-fluorodeoxyglucose-positron emission tomography avidity and response to locoregional therapy may also guide in ensuring acceptable tumor biology.…”

Research progress of protein induced by vitamin K absence or antagonist II in liver transplantation for hepatocellular carcinoma

“…Secondly, NX-DCP ≥ 90 mAU/mL and the PIVKA-II/NX-DCP ratio ≥ 1.5 were associated with significantly larger tumor size and more frequent PV invasion. Studies by Kurokawa T et al [ 24 ] and Yamazaki S et al [ 25 ] also found that NX-DCP had a higher sensitivity for detecting vascular invasion (VI) in HCC than PIVKA-II and AFP. Sorafenib was the first targeted drug used in treating HCC, and a Japanese retrospective study evaluated for the first time the effect of sorafenib on serum NX-DCP in HCC patients.…”