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Early detection of hepatocellular carcinoma associated with cirrhosis by combined assay of des-gamma-carboxy prothrombin and alpha-fetoprotein: a prospective study.

BACKGROUND/AIMS
To evaluate the usefulness of des-gamma-carboxy prothrombin (DCP) assay in a group of high risk for hepatocellular carcinoma (HCC).


PATIENTS AND METHODS
Plasma DCP and serum-alpha-fetoprotein (AFP) concentrations were prospectively measured in 137 patients with liver cirrhosis (LC).


RESULTS
During the mean observation period of 3.4 years, HCC developed in 35 patients (25.5%; yearly rate 7.5%), of whom 16 (45.7%) had a small tumor < or = 2 cm in diameter. Eight patients (22.9%) had significantly elevated DCP at the time of HCC detection. However, all these tumors measured > 2 cm and were multiple or diffuse type. In cases with a tumor diameter < or = 2 cm HCC was diagnosed by imaging and elevated AFP concentrations. In contrast, elevated DCP frequently leads to the detection of tumors > 2 cm or those of diffuse type, which are difficult to recognize with imaging.


CONCLUSIONS
Thus, although DCP alone is not sensitive enough to detect early small liver cancers, the use of both markers and imaging in the follow-up of patients with LC might be beneficial.