Diagnostic Role of Blood Tumor Markers in Predicting Hepatocellular Carcinoma in Liver Cirrhosis Patients Undergoing Liver Transplantation

Abstract

BACKGROUND The aim of this study was to investigate the diagnostic role of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) in predicting hepatocellular carcinoma (HCC) in patients with advanced liver cirrhosis (LC) awaiting liver transplantation (LT). MATERIAL AND METHODS During a study period of 10 years, 2074 adult LT recipients were identified. They were divided into 2 groups: HCC (n=970: 46.8%) and non-HCC (n=1104: 53.2%). They were stratified into 5 categories according to model for end-stage liver disease (MELD) scores: <10 (n=464), >/=10 and <15 (n=632), >/=15 and <20 (n=355), >/=20 and <30 (n=340), and >/=30 (n=283). RESULTS Median pretransplant AFP vs. DCP levels were 11.3 ng/mL vs. 26 mAU/mL and 4.2 ng/mL vs. 22 mAU/mL in the HCC and non-HCC groups, respectively. Receiver-operator characteristic (ROC) curve analyses showed that area under the curve (AUC) of AFP was 0.693, having a crossing-point cutoff at 6.8 ng/mL with sensitivity of 64.5% and specificity of 64.5%. AUC of AFP was inversely correlated with MELD score. AUC of DCP was 0.546, having a crossing-point cutoff at 25 mAU/mL with sensitivity of 53.1% and specificity of 51.8%. AUC of DCP was <0.6 except in MELD score >/=30. CONCLUSIONS Diagnostic predictability of AFP was reliably associated with MELD score but that of DCP was not. The sensitivity of AFP and DCP is not high enough, especially in patients with MELD score >/=20. Thus, thorough HCC screening with imaging studies should be conducted during the waiting period for LT and pretransplant assessment.