The role of tumor markers in the diagnosis of hepatocellular carcinoma, with special reference to the des-gamma-carboxy prothrombin

Authors

  • Gian Luca Grazi MD,

    Corresponding author
    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
    • Istituto di Clinica Chirurgica 2, Universita degli Studi di Bologna, Policlinico S. Orsola, Via Massarenti 9,40138 Bologna, Italy
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  • Alighieri Mazziotti,

    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • Cristina Legnani,

    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • Elio Jovine,

    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • Rita Miniero,

    1. Central Laboratory, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • Antonio Gallucci,

    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • Gualtiero Palareti,

    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • Giuseppe Gozzetti

    1. Second Department of Surgery, Department of Angiology and Blood Coagulation, University of Bologna, S. Orsola Hospital, Bologna, Italy
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  • This study was carried out in the context of the Research Doctorate (IV Cycle) on “Tumor markers of the gastrointestinal system” and supported in part by a research grant from CNR 90.04068.CT04.

Abstract

The assessment of new and more sensitive serum markers for hepatocellular carcinoma (HCC) represents a useful contribution to the diagnosis of small liver tumors, still amenable by surgery. We evaluated the efficacy of the tumor markers proposed during recent years for the study of HCC: alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), serum ferritin (SF), tissue polypeptide antigen (TPA), and, finally, the more recently proposed des-gamma-carboxy prothrombin (DCP). Of the 227 patients included in this retrospective study, 111 had HCC, and 85 of these were also cirrhotic. The remaining 116 patients, considered as the control group, included 23 patients with liver metastases from colorectal cancer, 26 with benign hepatic lesions, 20 with tumors other than HCC without hepatic metastases, and 47 with other liver diseases. For each single tumor marker, the sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and Younden index were assessed. AFP and DCP proved to be the most effective, with sensitivity, specificity, and diagnostic accuracy of 54.9%, 97.4%, and 76.6% and of 53.3%, 88.1%, and 71.1%, respectively. The same parameters evaluated for combined use of the two markers were 74.2%, 87.2%, and 80.9%, respectively. Analysis of the other markers produced no further significant contribution. Of the 111 patients with HCC, 35 (33.3%) were positive for both AFP and DCP, 43 (41%) were positive for one of them, and 27 (25.7%) were completely negative. In the 44 patients who underwent liver resection or transplantation, DCP correlated significantly with the histological presence of microvascular thrombosis, the major factor determining long-term survival after curative surgery. As a tumor marker for HCC, DCP is at least as effective as AFP; the combined use of AFP and DCP significantly improves the chances of identifying HCC by serodiagnosis Copyright © 1995 by the American Association for the Study of Liver Diseases.

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