Prediction of invasive activities in hepatocellular carcinomas with special reference to α-fetoprotein and des-γ-carboxyprothrombin

Background: Hepatocellular carcinoma (HCC) is one of the world's major malignancies, especially in Asian countries. To improve the prognosis of HCC, it is essential to predict its invasive behavior in both intra- and extra-hepatic modalities. For this purpose, we examined the predictive values of two tumor markers, α-fetoprotein (AFP) and des-γ-carboxyprothrombin (DCP). Methods: 194 HCC cases at the National Cancer Center Hospital were selected from the Pathology Records. Detailed information regarding the existence of extra-hepatic venous invasion (EHVI) at the portal vein and intra-hepatic multiple malignant tumors (IHMTs) were collected and combined with the preoperative AFP and DCP testing results. Furthermore, information about the viral infection status such as HBs antigen positive or HCV antibody positive or no viral hepatitis was obtained. The information was analyzed by the ROC (Receiver Operating Characteristic Curve) method. Results and conclusions: In both the EHVI group and the IHMT group, all the combinations except the HCV-positive group of IHMT revealed a tendency for DCP to offer better diagnostic accuracies, although this was statistically significant only in the HBs-positive group of IHMT. This result indicates either (1) that in a strict sense, DCP is not necessarily better than AFP at predicting the invasive characteristics or (2) that DCP is better than AFP at reflecting the invasive characteristics of HCC although not statistically significant. In either situation, from a long-term viewpoint, it is advisable to find a new marker or to re-evaluate the existing markers in order to predict the invasive characteristics more accurately.