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

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

World J Gastrointest Pathophysiol. 2024 Apr 22;15(1):90893. doi: 10.4291/wjgp.v15.i1.90893.

Authors

Muhammad Ali Qadeer¹, Zaigham Abbas², Shaima Amjad³, Bushra Shahid⁴, Abeer Altaf¹, Mehreen Siyal¹

Affiliations

¹ Department of Hepatogastroenterology, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan.
² Department of Hepatogastroenterology, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan. drzabbas@gmail.com.
³ Family Medicine, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan.
⁴ Internal Medicine, Dr. Ziauddin University Hospital Clifton, Karachi 75600, Pakistan.

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