Des-γ-carboxyprothrombin, α-fetoprotein and AFP-L3 in patients with chronic hepatitis, cirrhosis and hepatocellular carcinoma

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http://www3.interscience.wiley.com/journal/120122677/abstract

Journal of Gastroenterology and Hepatology

Volume 23 Issue 10, Pages 1541 - 1548

Published Online: 19 Apr 2008

HEPATOLOGY

Des-γ-carboxyprothrombin, α-fetoprotein and AFP-L3 in patients with chronic

hepatitis, cirrhosis and hepatocellular carcinoma

Francisco A Durazo,* Lawrence M Blatt,*† G Corey, ‡ Jiing-Huey Lin,

† Han,* Sammy Saab,* W Busuttil* and Myron J Tong*‡

*The Pfleger Liver Institute, Geffen School of Medicine, University of

California, Los Angeles, † Intermune, Brisbane, and ‡ Huntington

Research Medical Institutes, Pasadena, California, USA

Correspondence to Dr Francisco A Durazo, UCLA − Digestive and Liver Diseases,

200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA. Email:

fdurazo@...

Copyright Journal compilation © 2008 Blackwell Publishing Asia Pty Ltd and

Journal of Gastroenterology and Hepatology Foundation

KEYWORDS

α-fetoprotein • AFP-L3 • clinical • des-γ-carboxyprothrombin •

hepatocellular carcinoma • tumor marker

ABSTRACT

Background and Aim: Hepatocellular carcinoma (HCC) is a common complication in

patients with chronic viral hepatitis. Detection of HCC at an early stage is

critical for a favorable clinical outcome. The study aim was to: (i) compare the

levels of des-γ-carboxyprothrombin (DCP), α-fetoprotein (AFP) and AFP-L3 in

HCC patients and in chronic viral hepatitis patients without HCC; (ii) define

the level of each tumor marker with the best sensitivity and specificity for HCC

diagnosis; and (iii) to correlate the levels of these markers with respect to

size and tumor burden.

Methods: Two hundred and forty patients with either hepatitis B virus (HBV) or

hepatitis C virus (HCV) infection were studied. These included 144 with HCC, 47

with chronic hepatitis (fibrosis stage I–III on liver biopsy) and 49 with

cirrhosis.

Results: Levels of DCP, AFP and AFP L-3 were significantly higher in patients

with HCC than in those without HCC (P ≤ 0.0001). Receiver–operating curves

(ROC) indicated that the cut-off value with the best sensitivity and specificity

for each test was ≥84 mAU/mL for DCP, ≥25 ng/mL for AFP and ≥10% for

AFP-L3. The sensitivity, specificity and positive predictive value (PPV) for DCP

was 87%, 85% and 86.8%, for AFP 69%, 87% and 69.8%, and for AFP-L3 56%, 90% and

56.1%, respectively. DCP levels were below the ROC cut-off in all patients

without HCC. In patients with single lesions, there was a direct correlation of

DCP to tumor size. High levels of AFP correlated with diffuse type of HCC. All

three markers were significantly elevated in the presence of metastatic HCC. No

advantage was observed by combining two or three markers for HCC diagnosis.

Conclusion: DCP had the highest sensitivity and PPV for HCC diagnosis, had a

direct correlation with tumor size, and was not elevated in any patients without

HCC. DCP should be used as the main serum test for HCC detection.

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Accepted for publication 30 January 2008.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1440-1746.2008.05395