Diagnostic performance of tumor marker DCP in Mongolian patients with HCC

Abstract

Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide (for both genders) and the second most common cause of cancer death. Mongolia has the world’s highest liver cancer mortality rate, and HCC is the main cause of mortality. The poor survival rate is, in part, related to the diagnosis of HCC at advanced stages where effective therapies have been lacking. This study aimed to investigate the diagnostic significance of desgamma-carboxy prothrombin (DCP) in patients with chronic hepatitis and HCC. Methods: All patients who visited at Liver Center Hospital from June 2019 to December 2019 were enrolled (n = 367). Participants were divided into five groups. The first group was healthy controls. These were otherwise healthy participants with no history of liver disease, normal liver enzyme levels and no viral hepatitis risk factors. The next 3 groups included participants with chronic hepatitis B, C, and D. The last group was patients who had HCC confirmed by imaging and pathological history. Serum levels of DCP and AFP were measured on a HISCL 5000 (Sysmex Tokyo, Japan) using the HISCL DCP Assay kit and the HISCL AFP Assay kit, respectively, following the manufacturer’s instructions. Liver fibrosis was assessed by Fibroscan 502 (Echosens). Sensitivity and specificity were determined by ROC analysis. The statistical analyses were performed using SPSS software version 23.0. Results: The mean level of DCP was 27.23±9.2 (mAU/mL) in the healthy group, 34.74±20.6 (mAU/mL) in the chronic hepatitis B group, 32.48±32.3 (mAU/mL) in coinfection of chronic hepatitis B and D group, 30.68±14.15 (mAU/mL) in chronic hepatitis C group, and 486.7±621 (mAU/mL) in HCC group. The ALT, AST, AFP and DCP levels were higher in the HCC group than other groups (p<0.05). AFP level was extremely influenced by liver fibrosis level regardless of HCC presence (p=0.0001). In Barcelona stages (BCLC), the DCP serum level was significantly higher in the group with HCC. The AFP serum level showed no significant differences based on the BCLC stage. The sensitivity, specificity, positive predictive value, and negative predictive value at cut-off of 40 mAU/mL for DCP (AUC 0.942) were 89.8%, 84.6% 47.4% and 97.7%, respectively. The AFP at the same cut-off value was 10 ng/mL, with a sensitivity of 77.6% and a specificity of 79%. There was no significant difference between serum DCP level and ALT, AST level (n=367, p=0.946, 0.187), besides AFP value significantly correlated with AST level (r= 0.127, p=0.022). Conclusion: There were significant differences in DCP and AFP levels among HCC and other groups. The AFP level significantly increased with fibrosis score, while DCP was relatively constant. The sensitivity and specificity of DCP would be higher if the cut-off value was 40 mAU/mL instead of 10 mAU/mL.