Clinical Implication Of AFP, GPC3, DCP And VEGF In Hepatocellular Carcinoma:Diagnostic And Prognostic Variability

Aim:To evaluate whether the serum level of a-fetoprotein (AFP), Glypican-3(GPC3), des-y-carboxyprothrombin (DCP) and Vascular endothelial growth factor (VEGF) are useful as markers for the presence and progression of hepatocellular. carcinoma (HCC), and to determine the clinical utility of these tumor markers as predictors of treatment outcome in patients with HCC after hepatoectomy.Method:All229patients were divided into three groups:patients with HCC (n=136), liver cirrhosis (LC; n=47), along with healthy Controls having no liver-related diseases (n=46). The serum estimation of AFP, GPC3, DCP and VEGF were done to all subjects. All the tumor recurrence and survival data were recorded and analyzed accordingly.Results:For the detection of HCC, serum GPC3had the largest area under the curve (AUC) and the highest accuracy by receiver operating characteristic curve (ROC) analysis using the Youden index, which was similar to VEGF. Moreover, GPC3levels were elevated in the serum of50.6%(39/77) of individuals with HCC who had negative serum AFP levels. Compared with patients without tumor recurrence after surgery in HCC, the risk variables for recurrence were tumor invasiveness, microvascular invasion (MVI), total tumor size, Nonadherence to Milan criteria, DCP>350mAu/mL, VEGF>112pg/ml, and downstaging treatment. When stratified with MVI and Milan Criteria, the survival analysis for HCC recurrence indicated the significant advantage of MVI in predicting the early recurrence of HCC post-operation with regard to the Milan Criteria. Evaluation of various tumor markers in the HCC group showed that the serum DCP and VEGF level were similarly higher in patients with MVI than those without MVI, however, there were no significant differences of the serum levels of tumor markers among the different types of tumor invasiveness except for VEGF.Conclusion:The addition of a test for GPC3, as well as VEGF, might improve the performance of HCC screening in patients with Liver Cirrosis rather than AFP, while serum DCP and VEGF might be important for predicting tumor invasiveness and MVI, respectively.