TY - JOUR
T1 - Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in American patients
AU - Marrero, Jorge A.
AU - Su, Grace L.
AU - Wei, Wei
AU - Emick, Dawn
AU - Conjeevaram, Hari S.
AU - Fontana, Robert J.
AU - Lok, Anna S.
N1 - Funding Information:
Abbreviations: HCC, hepatocellular carcinoma; AFP, α-fetoprotein; DCP, des-gamma carboxy-prothrombin; CTP, Child-Turcotte-Pugh; ROC, receiver operating characteristic; AUROC, area under the ROC curve; ALT, alanine aminotransferase; AST, aspartate aminotransferase; PPV, positive predictive value; NPV, negative predictive value. From the 1Department of Internal Medicine, Division of Gastroenterology, and 2Department of Biostatistics, University of Michigan, Ann Arbor, MI. Received November 15, 2002; accepted February 26, 2003. Supported by AASLD Schering Advanced Hepatology Fellowship (J.A.M.), AGA Clinical Research Career Development Award (J.A.M.), NCI #CA86400 Early Detection Research Network (J.A.M.), and NIH M01-RR00042 to the General Clinical Research Center. Presented at the Annual Meeting of the American Association for the Study of Liver Disease, November 2001, Dallas, TX. Address reprint requests to: Jorge A. Marrero, M.D., University of Michigan, 3912 Taubman Center, Ann Arbor, MI 48109-0362. E-mail: jmarrero@ umich.edu; fax: 734-936-7392. Copyright © 2003 by the American Association for the Study of Liver Diseases. 0270-9139/03/3705-0020$30.00/0 doi:10.1053/jhep.2003.50195
PY - 2003/5/1
Y1 - 2003/5/1
N2 - Mortality due to hepatocellular carcinoma (HCC) has not improved over the last 20 years. This is in part due to the poor performance of available tumor markers leading to delays in diagnosis. Des-gamma carboxy-prothrombin (DCP) has been reported to be more sensitive and specific for the diagnosis of HCC in Japanese patients compared with α-fetoprotein (AFP). We conducted a cross-sectional case control study to evaluate whether DCP is more sensitive and specific than AFP for differentiating HCC from nonmalignant liver disease in a cohort of American patients from a single referral center. Four groups were studied: G1, normal healthy subjects; G2, patients with noncirrhotic chronic hepatitis; G3, patients with compensated cirrhosis; and G4, patients with histologically proven HCC. A total of 207 subjects were enrolled. Both DCP and AFP levels increased progressively from G1 to G4, but DCP values had less overlap among the groups than AFP. ROC curve indicated that a DCP value of 125 mAU/mL yielded the best sensitivity (89%; 95% CI, 77%-95%) and specificity (95%; 95% CI, 82%-96%) for differentiating patients with HCC from those with cirrhosis and chronic hepatitis. The optimal AFP cutoff value was 11 ng/mL and was inferior to the DCP value of 125 mAU/mL, the area under the ROC curves being 0.928 versus 0.810, respectively (P = .002). In conclusion, DCP was more sensitive and specific than AFP for differentiating HCC from nonmalignant chronic liver disease. Prospective studies to evaluate the role of DCP in early HCC are underway.
AB - Mortality due to hepatocellular carcinoma (HCC) has not improved over the last 20 years. This is in part due to the poor performance of available tumor markers leading to delays in diagnosis. Des-gamma carboxy-prothrombin (DCP) has been reported to be more sensitive and specific for the diagnosis of HCC in Japanese patients compared with α-fetoprotein (AFP). We conducted a cross-sectional case control study to evaluate whether DCP is more sensitive and specific than AFP for differentiating HCC from nonmalignant liver disease in a cohort of American patients from a single referral center. Four groups were studied: G1, normal healthy subjects; G2, patients with noncirrhotic chronic hepatitis; G3, patients with compensated cirrhosis; and G4, patients with histologically proven HCC. A total of 207 subjects were enrolled. Both DCP and AFP levels increased progressively from G1 to G4, but DCP values had less overlap among the groups than AFP. ROC curve indicated that a DCP value of 125 mAU/mL yielded the best sensitivity (89%; 95% CI, 77%-95%) and specificity (95%; 95% CI, 82%-96%) for differentiating patients with HCC from those with cirrhosis and chronic hepatitis. The optimal AFP cutoff value was 11 ng/mL and was inferior to the DCP value of 125 mAU/mL, the area under the ROC curves being 0.928 versus 0.810, respectively (P = .002). In conclusion, DCP was more sensitive and specific than AFP for differentiating HCC from nonmalignant chronic liver disease. Prospective studies to evaluate the role of DCP in early HCC are underway.
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U2 - 10.1053/jhep.2003.50195
DO - 10.1053/jhep.2003.50195
M3 - Article
C2 - 12717392
AN - SCOPUS:0037698789
SN - 0270-9139
VL - 37
SP - 1114
EP - 1121
JO - Hepatology
JF - Hepatology
IS - 5
ER -