Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Apr 22, 2024; 15(1): 90893
Published online Apr 22, 2024. doi: 10.4291/wjgp.v15.i1.90893
Des-gamma-carboxy prothrombin and alpha-fetoprotein levels as biomarkers for hepatocellular carcinoma and their correlation with radiological characteristics
Muhammad Ali Qadeer, Zaigham Abbas, Shaima Amjad, Bushra Shahid, Abeer Altaf, Mehreen Siyal
Muhammad Ali Qadeer, Zaigham Abbas, Abeer Altaf, Mehreen Siyal, Department of Hepatogastroenterology, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan
Shaima Amjad, Family Medicine, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan
Bushra Shahid, Internal Medicine, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan
Co-first authors: Muhammad Ali Qadeer and Zaigham Abbas.
Author contributions: Qadeer MA and Abbas Z contributed equally to the manuscript; Qadeer MA drafted the manuscript, supervised data collection, and assisted in data analysis; Abbas Z conceived the study, performed data analysis, supervised manuscript writing, and revised manuscript according to the reviewers’ comments; Amjad S, Shahid B, Altaf A, and Siyal M were involved in the data collection; and all authors read the final manuscript and approved it.
Institutional review board statement: The study was reviewed and approved by Dr. Ziauddin University’s Ethical Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zaigham Abbas, AGAF, FACG, FACP, FCPS, FRCP, MBBS, Professor, Department of Hepatogastroenterology, Dr. Ziauddin University Hospital, 4/B Shahrah-e-Ghalib Rd, Block 6, Clifton, Karachi 75600, Pakistan. drzabbas@gmail.com
Received: December 16, 2023
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
Abstract
BACKGROUND

Alpha-fetoprotein (AFP), a commonly used biomarker for hepatocellular carcinoma (HCC), is normal in up to one-third of patients.

AIM

To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin (DCP) alone and in combination with AFP.

METHODS

In this study, 202 patients with radiologically proven HCC were enrolled, and their DCP and AFP levels were evaluated for their diagnostic performance.

RESULTS

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.

CONCLUSION

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.

Keywords: Des-gamma-carboxy prothrombin; Protein induced by vitamin K absence-II; Cirrhosis; Alpha-fetoprotein; Biomarkers; Hepatocellular carcinoma; Portal vein thrombus

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.