Des-y-carboxy prothrombin as screening marker for patients with de novo hepatocellular carcinoma

ABSTRACT

To evaluate the predictability of estimation of serum Des-y-carboxyprothrombin [DCP] in cirrhotic and chronic hepatitis C [CHC] patients for the development of de novo hepatocellular carcinoma [HCC] in comparison to alpha-fetoprotein [APP]. The study included 90 patients; 30 patients with CHC, 20 patients with HCC and 30 compensated cirrhotic patients and 10 controls. Patients with CRC and cirrhosis were followed up for de novo development of HCC by sonography and/or computed tomography [CT]. Blind liver biopsies were done and histopathological inflammatory activity and fibrosis stage of CHC and cirrhotic patients were evaluated according to Scheuer classification and HCC was also graded. For all patients and controls serum levels of DCP and alpha fetoprotein were measured by enzyme linked immunosorbent assay [ELISA]. Serum levels of AFP and DCP were significantly elevated in patients' groups compared to control group and in HCC patients compared to CRC and cirrhosis groups with significantly elevated levels in cirrhotic patients compared to CHC patients. There was a positive correlation between serum levels of both DCP and AFP and total Scheuer score in cirrhotic and CRC groups and HCC pathological grading. Regression analysis of serum levels of DCP and AFP defined DCP as the significant predictor for pathological grading of HCC and the combined use of both markers improved the predictability of AFP. Throughout follow-up period, 4 [13.3%] cirrhotic patients developed HCC. ROC curve analysis showed that estimation of serum DCP [AUC=0.892] was significantly more specific predictor for de novo HCC than AFP [AUCzO.608]. ROC analysis defined serum DCP and AFP levels at 38 mAU/ml and 16 ng/ml as cutoff point for prediction of de novo HCC with AUC=0.698 and 0.565, specificity rate of 887% and 73.6%. accuracy rate of 86.7% and 70%, and sensitivity rate of 71 .4% and 42.9%, respectively. Serum DCPin cirrhotic and CHC patients free of HCC could predict de novo development of HCC with higher specificity than AFP but diagnostic validity could be improved by estimation of both markers