Clinical Utility of Simultaneous Measurement of Serum High-sensitivity Des-gamma-carboxy Prothrombin and Lens Culinaris Agglutinin A-reactive Alpha-fetoprotein in Patients with Small Hepatocellular Carcinoma

Objective: To evaluate the diagnostic efficacy of simultaneous measurements of high-sensitivity des-gamma-carboxy prothrombin (H-DCP) and Lens culinaris agglutinin A-reactive alpha-fetoprotein (AFP-L3) in small hepatocellular carcinoma (HCC).

Methods: Sixty-one patients with small HCCs < or = 2 cm in diameter and 134 controls (chronic hepatitis: 59 cases; cirrhosis: 75 cases) were examined. H-DCP was measured by electrochemiluminescence immunoassay (cut-off 40 mAU/ml (milli-arbitrary units/ml) and AFP-L3% (percentage of AFP-L3/total AFP) by lectin-affinity electrophoresis coupled with the antibody-affinity blotting method (cut-off 10%). Fifty-six patients were histologically diagnosed and the remaining five patients were diagnosed clinically.

Results: Of 61 patients, 27 (44.3%) were positive for H-DCP and 14 (23.0%) were positive for AFP-L3. There was no correlation between H-DCP and AFP-L3%. Nineteen patients (31.1%) had positive H-DCP alone. Six patients (9.8%) had positive AFP-L3 alone, and in eight patients (13.1%) both markers were positive. In combination assay, 33 of 61 patients (54.1%) were positive for either marker; specificity and accuracy were 97.8% and 84.1%, respectively. There was a tendency for the AFP-L3% to be elevated in patients with moderately or poorly differentiated HCC (P= 0.0564) and multiple HCC nodules (P= 0.0316), while the H-DCP showed no elevation related to the tumour type.

Conclusion: The detection rate of small HCC was improved by combination assay with H-DCP and AFP-L3%. Our results indicate that the markers are complementary and useful for the diagnosis and evaluation of small HCC when measured simultaneously.