Diagnostic accuracy of α-fetoprotein and des-γ-carboxy prothrombin in screening for hepatocellular carcinoma in liver transplant candidates


Dr Yasuhiko Sugawara, Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: yasusuga-tky@umin.ac.jp


Aim:  Although hepatocellular carcinoma (HCC)-specific serum tumor markers, α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP), are used in the screening for HCC, their utility in pre-transplantation evaluation is not well established. This study aimed to evaluate the accuracy of AFP and DCP measurement for the diagnosis of HCC in liver transplant candidates.

Methods:  A total of 315 consecutive adult patients (174 men and 141 women, mean age 52 years), who were to receive liver transplantation for end-stage liver diseases, were enrolled. The pre-transplant levels of AFP and DCP were compared with the histopathology of explanted liver.

Results:  Hepatocellular carcinoma was present in the explanted liver of 106 recipients (median number of nodules 2, mean diameter 2.5 cm). The area under receiver operating characteristic curve for the diagnosis of HCC was 0.83 (95% confidence interval, 0.78–0.88) for AFP and 0.47 (0.41–0.54) for DCP. With the cut-off value of 100 mAU/mL, 20/106 (18.9%) patients with HCC and 54/194 (27.8%) patients without HCC were positive for DCP. DCP positivity was associated with vascular invasion, tumor differentiation and size among patients with HCC, which was associated with albumin level among patients without HCC. Vitamin K was administered prior to transplantation to 20 patients who were positive for DCP (two with and 18 without HCC), resulting in a decrease in DCP levels in 19 of them.

Conclusions:  Serum DCP levels may be raised in end-stage liver disease patients without HCC, and cannot be used as a reliable marker for HCC among liver transplant candidates.