Significance of alpha-fetoprotein and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma undergoing hepatectomy.

BACKGROUND

Alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) are well-known tumor markers of hepatocellular carcinoma (HCC). The aims of this study are to calculate the sensitivity/specificity of AFP and DCP measurement for the diagnosis of HCC, measure response rates of the markers following curative-intent resections, determine the correlations between the marker levels and clinicopathological prognostic variables, and determine the correlations between the marker levels before hepatectomy and those at diagnosis of recurrence.

METHODS

A retrospective cohort study of 714 consecutive patients with HCC undergoing hepatectomy was carried out.

RESULTS

The areas under the receiver operating characteristic curves were 0.79 versus 0.91 for AFP and DCP, respectively (P < 0.001). Positive AFP and DCP status became negative at 6 months post surgery in 184/229 (80.3%) and 245/246 (99.6%) patients, respectively (cutoff values being 20 ng/ml for AFP and 40 mAU/ml for DCP; P < 0.0001). No correlation was found between marker levels (rs = 0.23). The level of DCP, but not that of AFP, showed a close correlation with tumor size (rs = 0.51 and 0.19, respectively). They were associated with indices of tumor invasiveness without showing any specific associations. AFP and DCP levels in patients showing recurrence in </=6 months correlated with the levels measured before surgery (rs = 0.78 and 0.49, respectively) but not in those showing recurrence after 2 years (rs = 0.31 and 0.30, respectively).

CONCLUSIONS

DCP is a more accurate, albeit complementary, HCC marker than AFP. While the levels of both markers increased with advancing tumor growth, no specific associations were found. The marker values at recurrence indicated the type of recurrence.