Serum des - gamma - carboxy [abnormal] prothrombin as a marker for hepatocellular carcinoma in Egyptian patients in comparison with alpha-fetoprotein using receiver operation characteristic analysis

To evaluate Des-gamma-carboxy prothrombin [DCP] level as an early detection of hepatocellular carcinoma in Egyptian patients in camparison with alphafetoprotein. Serum DCP and Alpha-fetoprotein [AFP] levels were measured in 132 cases of chronic liver diseases including 40 patients with liver cirrhosis; 32 patients with chronic hepatitis and 60 patients with hepatocellular carcinoma [HCC]. DCP levels were significantly higher in patients with HCC than those with chronic hepatitis [p<0.001] and cirrhosis [p<0.001], no significant difference was found between patients with cirrhosis or with chronic hepatitis and controls. In patients with hepatocellular carcinoma, DCP was correlated with the size of the tumor and the histopathologic grades but not to the Child Pugh grades and most of the liver function tests. Using the receiver operative characteristic [ROC], the cut-off value for the DCP and AFP were set as 40 mAU/ml and 100 ng/ml, respectively, that differentiate patients with HCC from those with cirrhosis. At this level, the sensitivity, the specificity, and diagnostic accuracy of DCP were 78.3%, 86.0% and 83.4; respectively. The sensitivity, specificity, and diagnostic accuracy of AFP were 56.7%, 96% and 70.0% ; respectively. The simultaneous determination of AFP and DCP raised the sensitivity of the test to 84% with specificity of 100% and diagnostic accuracy of 90% . The area under the ROC curves revealed that DCP had a better accuracy than AFP in diagnosis of HCC [0.85 [95% Cl 0.78-0.91 lVs 0.73 [95% Cl, 0.65-0.81], [p=0.013]. Both AFP and DCP are good markers for HCC and their simultaneous determination may improve the detection of HCC in cirrhotic patients negative for AFP