Des-Gamma-Carboxyprothrombin for Early Identification and Prognosis of Hepatocellular Carcinoma - A Case Control Study from Western Nepal


Objective: To assess the diagnostic and prognostic value of AFP and des-gamma-carboxyprothrombin (DCP)in combination and alone for hepatocellular carcinoma. Materials and
Methods: A case control study carriedout in the Department of Biochemistry of Manipal College of Medical Sciences, Pokhara, Nepal between 1stJanuary 2010 and 31st December 2011. The variables collected were age, gender, BMI, total proteins, albumin,AST, ALT, total bilirubin, DCP, AFP. Approval for the study was obtained from the institutional research ethicalcommittee. Estimation of AFP was performed by ELISA reader for all cases. Analysis was done using descriptivestatistics and confidence interval (CI). The data was analyzed using Excel 2003, R 2.8.0 Statistical Packagefor the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1Windows Version.
Results:The mean age of HCC cases was 53.6 ± 14.93 yrs. The percentage of females was lessthan males in both cases (23%) and controls (29%). The specificity of DCP reached 100% when its values wasequal or greater than 150 (MAU/ml) for 0, 3, 6, 9, 12 months preceding the diagnosis of HCC. Similarly, thespecificity for AFP was also nearly 100% when its value was equal or greater than 200 ng/ml 0, 3, 6, 9, 12 monthsearlier to the finding of HCC. The specificity of DCP (≥40MAU/mL) and AFP(≥20 ng/mL) in combination was93%, 97%, 95%, 96%, 97% in respect to 0, 3, 6, 9, 12 months prior to the diagnosis of HCC.
Conclusion: Thecombination of both DCP and AFP will improve the finding of initial HCC and the sensitivity of these markerswas utmost at the time of HCC identification and noticeably lesser at former time points.