Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in American patients
Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in American patients
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DOI：
10.1053/jhep.2003.50195
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发表时间：
2003-05-01
期刊：
影响因子：
13.5
通讯作者：
Lok, AS
中科院分区：
文献类型：
--
作者：
Marrero, JA;Su, GL;Lok, AS
过去20年来，肝细胞癌（HCC）的死亡率并未改善。这部分是由于可用的肿瘤标志物的性能差，导致诊断延迟。据报道，与甲胎蛋白（AFP）相比，脱-γ羧基凝血酶原（DCP）在日本患者中诊断HCC更敏感和特异。我们进行了一项横断面病例对照研究，以评估DCP是否比AFP更敏感和特异性区分HCC和非恶性肝病在一个队列的美国患者从一个单一的转诊中心。研究了四组：G1，正常健康受试者; G2，非肝硬化性慢性肝炎患者; G3，代偿性肝硬化患者; G4，组织学证实的HCC患者。共入组207例受试者。DCP和AFP水平从G1到G4均逐渐增加，但DCP值在各组之间的重叠比AFP少。ROC曲线显示，DCP值为125 mAU/mL时，区分HCC与肝硬化和慢性肝炎的敏感性（89%; 95%CI，77%~ 95%）和特异性（95%; 95%CI，82%~ 96%）最佳。最佳AFP截断值为11 ng/mL，低于DCP值125 mAU/mL，ROC曲线下面积分别为0.928和0.810（P = 0.002）。结论：DCP在鉴别HCC与非恶性慢性肝病方面比AFP更敏感和特异。评估DCP在早期HCC中作用的前瞻性研究正在进行中。
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 a-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.