The Application Of DCP In Hepatocellular Carcinoma

BackgroundPrimary hepatic carcinoma(PHC)is the fifth most common malignant tumor in both sexes worldwide and is the second leading cause of cancer related-death in males.PHC is insidious,and most patients can not undergo operation when they have obvious clinical symptoms.Transcatheter arterial chemotherapy and embolization(TACE)is internationally recognized treatment method for patients with advanced primary liver cancer,which slows tumor growth and prolongs life survival.Early detection of PHC through serological and imaging methods can significantly improve the prognosis of patients.Serum alpha-fetoprotein(AFP)is commonly used to diagnose PHC.However,the sensitivity and specificity of AFP both are not high enough,the misdiagnosis are often inevitable.Thus,a more accurate method for detecting HPC is needed.Protein induced by vitamin K absence or antagonist-II(PIVKA-?),also called des-?-carboxy-prothrombin(DCP),is one of the most important serological markers in PHC.Futher studies about the application value are required.ObjectiveTo evaluate the diagnostic value in DPC and the therapeutic value in TACE for patients with PHC.MethodsWe included 49 patients with primary hepatic carcinoma in department of infectious diseases from Shandong Provincial Hospital from October 2016 to September 2017,and 49 cases of liver cirrhosis patients as control group.To study the value of AFP,DCP and joint application value in the diagnosis of PHC.TACE was used as the initial therapy.One month later,the imaging examination was performed to evaluate the therapeutic effect of liver cancer by mRECIST standard.To find the short-term prognostic factors of liver cancer after TACE and compare the efifect of DCP and AFP on short-term prognosis.To evaluate the value of DCP changes in the treatment outcome after TACE.Results1.Correlation analysis was performed on baseline serum AFP,DCP expression level and basic clinical data.The results showed that there are no relationship between gender,age,etiology,Child-Pugh score,tumor number and the expression level.The expression level of DCP was correlated with BCLC staging(P=0.042)and tumor diameter(P=0.002).2s In our research,sensitivity=0.796,specificity= 0.837,AUC=0.863 for DCP,sensitivity =0.633,specificity=0.857,AUC=0.788 for AFP,The combined monitoring of the two indicators shows that the area under the ROC curve is 0.845,slightly worse than that of DCP,but there is no statistical significance(P=0.622).The diagnostic accuracy of DCP were better than that of AFP.3.MRECIST standard was used to evaluate the efficacy of the first TACE postoperative treatment among AFP,DCP positive and negative patients,and no significant difference was observed between different prognostic groups among AFP and DCP group.4.The relationship between gender,tumor emboli,child,tumor diameter(>5 cm),tumor number(>4),the AFP levels(>200 ng/ml),DCP levels(>400 miu/ml)and imaging changes in patients was analysed with univariate and multivariate analysis of variance,In addition to turmor diameter,there was no correlation between the residual variables.The results showed that among the 49 patients,a complete radiologic remission is achieved in 36 cases and 13 cases achieved radiographic progression.Among the 22 patients with tumor diameter more than 5cm,13 cases(59.1%)improved,36 cases(40.9%)worsened.Among the 27 patients with tumor diameter less than 5cm,23 cases(85.2%)improved,3 cases(14.8%)worsened.In the multivariable analysis,tumor diameter was an independent risk factor(OR:3.98,95%CIl.022-15.51,P=0.046)?5?The imaging and serological reexamination of the patients was performed in the first month after TACE surgery,and 36 of the 49 patients(73.4%)had achieved imaging partial or complete remission.Among these patients,the level of DCP had decreased>30%compared with baseline in 23 patients(63.8%).In the 6 patients with radiographic progression,the level of DCP had increased>20%compared with baseline in 5 patients(83.3%),The difference was statistically significant(?2= 15.11,P=0.004),the change of DCP can reflect the change of imaging.For serum AFP,13 patients were not able to measure owing to beyond the monitoring scope at baseline.In 17 patients,AFP was in normal range,and the serum AFP changes were not accurately assessed in this part of patients.In the remaining 19 cases,14 patients(73.6%)had achieved imaging partial or complete remission and the level of DCP had decreased>30%compared with baseline in 13 patients(92.8%).Conclusions1.Serum DCP level was significantly correlated with BCLC staging,and was not correlated with gender,age,etiology,Child-Pugh score,and tumor number.2.The serum DCP level has a good diagnostic value for liver cancer in patients with cirrhosis,which is better than that of AFP.3.There was no significant correlation between baseline serum DCP level and short-term therapeutic effect of TACE.4.The changes of serum DCP can be used to assess the therapeutic effect of TACE.