Affiliations: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
Correspondence:
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Corresponding author: Michael L. Volk, 6312 Medical Science Building 1, 1150 W Medical Center Drive, Ann Arbor, MI 48109, USA. Tel.: +1 734 647 4844; Fax: +1 734 647 3301; E-mail: mvolk@med.umich.edu.
Note: [1] This work was supported by CA864000 Great Lakes New England Clinical Epidemiology Center of the Early Detection Research Network, DK64909 and DK066840 (JAM).
Abstract: Current surveillance strategies for hepatocellular carcinoma (HCC) are applied uniformly in patients with cirrhosis, regardless of their cancer risk. The aim of this study was to compare the performance characteristics of the biomarkers alpha-fetoprotein (AFP), des-gamma carboxyprothrombin (DCP), and lectin-bound AFP (AFP-L3) in the diagnosis of HCC, and to determine the effect of risk factors for HCC on test performance. Eighty-four patients with HCC and 169 patients with cirrhosis were enrolled and their serum analyzed for total AFP, AFP-L3 and DCP. Receiver-operating characteristic (ROC) curves were constructed to determine the performance characteristics. DCP was significantly better than total AFP or AFP-L3 in differentiating HCC from cirrhosis, with a sensitivity of 86% and specificity of 93%. When subjects were divided into two groups by their risk for HCC, all 3 markers had a lower sensitivity and area under the ROC curve in the high-risk group compared to the low-risk group. In conclusion, DCP has the best performance characteristics of all 3 serum markers for the diagnosis of HCC. Serum biomarkers may be less sensitive and specific in the highest risk patients.
