Published online Apr 22, 2024. doi: 10.4291/wjgp.v15.i1.90893
Peer-review started: December 16, 2023
First decision: January 31, 2024
Revised: February 13, 2024
Accepted: March 26, 2024
Article in press: March 26, 2024
Published online: April 22, 2024
Processing time: 124 Days and 10.7 Hours
Alpha-fetoprotein (AFP), a commonly used biomarker for hepatocellular car
To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin (DCP) alone and in combination with AFP.
In this study, 202 patients with radiologically proven HCC were enrolled, and their DCP and AFP levels were evaluated for their diagnostic performance.
The mean age of the enrolled patients was 58.5 years; 72.0% were male. DCP was elevated in 86.6% (n = 175) of all patients, 100.0% (n = 74) of patients with portal vein thrombus, and 87.4% (n = 111) of patients with multicentric HCC. AFP was elevated in 64.3% (n = 130) of all the patients, 74% (n = 55) of the patients with portal vein thrombus, and 71.6% (n = 91) of the patients with multicentric HCC (P = 0.030, 0.001, and 0.015, respectively). In tumors less than 2 cm in size (n = 46), DCP was increased in 32 (69.5%) patients, and AFP was increased in 25 (54.3%) patients (P = 0.801). There was good pairing between DCP and AFP for HCCs of 2 cm size or larger (P < 0.001); however, the pairing among tumors < 2 cm size was not significant (P = 0.210). In 69 of the patients (34.1%), only one of the tumor markers was positive; DCP was elevated alone in 57/202 (28.2%) of all patients, and AFP alone was elevated in 12/202 (5.9%) of the patients. The areas under receiver operating characteristic curves (AUROC) for tumors > 2 cm was 0.74 for DCP and 0.59 for AFP; combining both markers resulted in an AUROC of 0.73. For tumors < 2 cm, the AUROC was 0.25 for DCP and 0.40 for AFP.
DCP, as an individual marker, had a better diagnostic performance in many cases of HCC. Hence, DCP may replace AFP as the primary HCC biomarker.
Core Tip: In this prospective study, the performance of des-gamma-carboxy prothrombin (DCP) relative to alpha-fetoprotein (AFP) was assessed in 202 patients diagnosed with hepatocellular carcinoma (HCC). DCP, when used as a standalone marker, exhibited superior diagnostic performance compared to AFP. Combining both tumor markers increased the overall detection rate of HCC, particularly in tumors less than 2 cm in length. Nevertheless, it is recommended that, if a single tumor marker is used, DCP is preferred. The role of DCP as a screening biomarker should be incorporated into the HCC guidelines.