Impact of tumor markers in diagnosis of patients with hepatocellular carcinoma (HCC) and their clinicopathologic correlation: an interim analysis

Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and its incidence is rising. Diagnosis is mainly based on ultrasound performance whereas AFP measurement is not recommended according the current AASLD guidelines. The aim of this study is to determine the usefulness of α –fetoprotein (AFP), AFP-L3% and des-γ-carboxyprothrombin (DCP) in diagnosis of HCC and their correlation to clinicopathologic parameters. Methods: Both serum samples of 75 patients with confirmed HCC according the AASLD guidelines receiving transarterial chemoembolisation and of 175 patients with liver cirrhosis without evidence of HCC were prospectively collected. AFP, AFP–L3% and DCP were measured using a micro–total analysis system. Diagnostic accuracy was determined by ROC analysis reporting sensitivity, specificity and the area under the curve (AUC) with 95% confidence interval. Differences in marker values were calculated using non –parametric tests.Results: Optimal cut-off values for AFP, AFP – L3% and DCP were 10 ng/ml, 10% and 2.87 ng/ml with an AUC of 0.745, 0.784 and 0.777 respectively. Combination of all markers showed superior diagnostic accuracy with an AUC of 0.912 and yielded sensitivity and specificity of 93% (87% –99%) and 70% (63%–77%). Regarding patients with AFP < 20 ng/ml AFP-L3% showed sensitivity and specificity of 68% (54%–83%) and 89% (84%–94%) using 10% as the cut-off value. AFP, AFP – L3% and DCP were significantly higher in patients with multilocular HCC (p=0.008, p=0.004 and p=0.011 respectively). Moreover larger tumors and higher BCLC stage were associated with higher DCP values (p=0.042 and p=0.003). Conclusions: Combination of all markers showed a better diagnostic accuracy than using them alone. In patients with AFP < 20ng/ml AFP-L3% can be helpful in diagnosing HCC. DCP yielded a better association with clinicopathologic parameters than AFP and AFP-L3% and may provide further information concerning disease state.

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Tumor marker - clinicopathologic correlation - diagnosis - hepatocellular carcinoma