A Combination of α-Fetoprotein and Des-γ-Carboxy Prothrombin Is Superior in Detection of Hepatocellular Carcinoma (original) (raw)
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Research Articles| February 08 2013
aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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aDepartment of Gastroenterology and Hepatology, and bCentral Laboratory, University Hospital Essen, cDepartment of Bioinformatics, Center for Medical Biotechnology, University of Duisburg-Essen, Essen, dWAKO Chemicals GmbH, Neuss, and eDepartment of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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Digestion (2013) 87 (2): 121–131.
Accepted:
November 20 2012
Published Online:
February 08 2013
Abstract
Background and Aim: The incidence of hepatocellular carcinoma (HCC) is increasing in western countries. Despite its low sensitivity, the diagnosis of HCC still depends on detection of α-fetoprotein (AFP). Therefore, the aim of this study was to evaluate the combined analysis of AFP and des-γ-carboxy prothrombin (DCP) in a European cohort. Methods: We performed a single-center study (164 HCC/422 controls), in which the serum concentrations of AFP and DCP were determined. Results: AFP and DCP were elevated in HCC patients compared to controls (p < 0.0001). By combination of AFP and DCP, the sensitivity was improved from 28.7% for AFP (cutoff 400 ng/ml; AFP at cutoff 10 ng/ml: 54.9%) to 78.0% using cutoffs of 10 ng/ml for AFP and 5 ng/ml for DCP (DCP alone, cutoff 5 ng/ml: 63.4%). Among early-stage patients, the sensitivity increased from 20% for AFP (cutoff 400 ng/ml; AFP at cutoff 10 ng/ml: 38%) to 55% in combination (DCP alone, cutoff 5 ng/ml: 47%). The area under the curve (AUC) for AFP and DCP was similar (AFP: 0.88; DCP: 0.87; combined: 0.91). Among non-cirrhotic patients, DCP (AUC: 0.93) showed a better performance than AFP (AUC: 0.84). Especially patients with non-alcoholic steatohepatitis had a high percentage of DCP-positive tumors. Conclusion: The data suggest that AFP alone is not sufficient for the serological diagnosis of HCC in European patients, while a combination of AFP and DCP can increase the sensitivity even in early-stage patients.
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