Better detection of Hepatocellular Carcinoma by combining Alphafeto-Protein (AFP) and Des-Gamma-Carboxyprothrombin (DCP)

Introduction. Hepatocellular Carcinoma (HCC) is the fifth most common tumor worldwide with increasing incidence. Screening and diagnosis depend on ultrasound and the biomarker Alphafetopreotein (AFP), but AFP has a low sensitivity. Aim. The aims of this study were to determine (i) the sensitivity and specificity of AFP, Desgamma-Carboxy-Prothrombin (DCP), and Lens-cullinaris-Antigen (AFP-L3%) within a northern European cohort, (ii) whether the sensitivity could be increased in combined measurement and (iii) whether other factors alter these results.Materials and Methods. We performed a single-center, prospective, case-control study including 164 HCC patients and 422 controls between 02/2007 and 11/2008. The serum concentration of AFP and DCP, and the percentage of AFP-L3 were determined using the Wako LiBASys clinical auto-analyzer by a liquid-phase binding assay. Results. AFP, DCP and AFP-L3% were significantly elevated in HCC patients compared to controls (P < .0001). AFP and DCP showed equal sensitivities, but in combination the sensitivity was elevated from 28.7% for AFP alone (cutoff level of 400 ng/ml) up to 78.0% for all HCC patients using cutoff levels of 10 ng/ml for AFP and 5 ng/ml for DCP with a specificity of 89.3%. Even within early-stage (BCLC) patients the sensitivity could be elevated to 64.6%. The area under the ROC was 0.88 and 0.87 for AFP and DCP, respectively, and could be elevated to 0.91 for all biomarkers together. Discussion. AFP alone is not sufficient for screening and diagnosis of HCC patients, but a combination of AFP and DCP can elevate the sensitivity dramatically even within early-stage patients. We state that AFP and DCP should be used simultaneously in the setting of screening patients at risk and to differentiate liver tumors.

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