Des-γ carboxyprothrombin may not be a good biomarker for hepatocellular carcinoma in those chronically infected with hepatitis B virus with basal core promoter double mutations (T^{1762}, A^{1764}), a prospective study
Affiliations: [a] Department of Public Health of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China | [b] Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China | [c] Division of Medicine, UCL Medical School, London, UK | [d] School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China
Correspondence:
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Corresponding author: Zhong-Liao Fang, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, 18 Jin Zhou Road, Nanning, Guangxi 530028, China. Tel.: +86 771 2518306; Fax: +86 771 2518768; E-mail:zhongliaofang@hotmail.com
Abstract: BACKGROUND: The accuracy of des-γ -carboxyprothrombin (DCP)
in the detection of hepatocellular carcinoma (HCC) in those infected
hepatitis B virus (HBV) from cross-sectional or case-control studies is contradictory. OBJECTIVE: To resolve this contradiction using a prospective
study. METHODS: Three hundred male individuals persistently infected
with HBV were recruited from the Chinese cohort and followed up once per
year from 2012 to 2015. Each subject was screened for HCC by measurements of
serum alpha-fetoprotein (AFP), lectin-bound α -fetoprotein (AFP-L3),
DCP concentrations and ultrasonographic examinations. RESULTS: Nineteen HCC cases were identified. The area under
receiver operating characteristic (AUROC) at first, second and third visit
for AFP, AFP-L3 and DCP ranges from 0.710-0.897, 0.566-0.637 and
0.520-0.595, respectively. The rate of elevated DCP is not significantly
different between the HCC cases and controls (52.6% vs. 47.4%)
(P > 0.05). The incidence of HCC in subjects with elevated DCP is not
significantly higher than that of those with normal DCP (9.5% vs.
4.6%) (P > 0.05). The AUROC of combinations of these biomarkers was
higher than that of AFP alone at the first visit. However, it was reduced at
the second visit. At the third visit, the AUROCs of AFP + DCP and AFP +
AFP-L3 + DCP, but not that of AFP + AFP-L3, were higher than that of AFP
alone. CONCLUSIONS: AFP but DCP or AFP-L3 remains a valuable biomarker
for HCC in those chronically infected with HBV. The combination with AFP-L3
and DCP may not increase the accuracy of AFP in differentiating HCC cases
from controls, among those infected with HBV.
Keywords: Hepatocellular carcinoma, hepatitis B virus, serum biomarker, the area under receiver operating characteristic
