The des-gamma-carboxy prothrombin index is a new prognostic indicator for hepatocellular carcinoma.
BACKGROUND
Des-gamma-carboxy prothrombin (DCP) has been reported to be an important prognostic factor in patients with hepatocellular carcinoma (HCC). Recently, a monoclonal antibody, 19B7, which recognizes the Gla domain of DCP, has been identified. The 19B7 antibody recognizes an epitope different from that recognized by MU-3, which is another antibody against DCP. In this study, the authors investigated the measurement of DCP using the antibodies MU-3 and 19B7, respectively, as a prognostic factor for patients with HCC who had solitary, small tumors and or Child Stage A HCC.


METHODS
One hundred four patients with HCC who had solitary, small tumors or Child Stage A tumors were enrolled in the study between 1991 and 2001. All patients were treated and were followed for a mean of 3.2 years. The authors analyzed the correlation between the DCP Index (DCP measured by MU-3 and DCP measured by 19B7) and patient prognosis. The patients were classified into 3 groups based on their DCP Index: 1) DCP negative (DCP < 40 milli arbitrary unit (mAU)/mL)); 2) low DCP Index (DCP > or = 40 mAU/mL; MU-3:19B7 ratio, < 3.0; and 3) high DCP Index (DCP > or = 40 mAU/mL; MU-3:19B7 ratio, > or = 3.0).


RESULTS
The survival rate for patients in the high DCP Index group was lower compared with the survival rate for patients in the DCP-negative group and was significantly lower compared with the survival rate for patients in the low DCP Index group. In a univariate Cox proportional hazards model, the positive factors were high DCP Index and low DCP Index. Among the positive predictive factors that were analyzed using a multivariate Cox proportional hazards model were age (hazard ratio, 3.27; P = 0.006), low DCP Index (hazard ratio, 2.87; P = 0.012), and high DCP Index (hazard ratio, 12.3; P < 0.0001).


CONCLUSIONS
The prognosis of patients who had a high DCP Index score was poorer compared with patients who had a low DCP Index score and patients who were classified as DCP negative. The authors concluded that the DCP Index is a prognostic indicator for patients with HCC.
Nagaoka
Sakae
S
National Nagasaki Medical Center Institute for Clinical Research, World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis, Nagasaki, Japan.
Yatsuhashi
Hiroshi
H
Hamada
Hisayuki
H
Yano
Koji
K
Matsumoto
Takehiro
T
Daikoku
Manabu
M
Arisawa
Kokichi
K
Ishibashi
Hiromi
H
Koga
Michiaki
M
Sata
Michio
M
Yano
Michitami
M
D000368:Aged; D000911:Antibodies, Monoclonal / Q000097:blood*; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood* / Q000276:immunology; D011516:Prothrombin / Q000276:immunology; D011933:Reagent Kits, Diagnostic; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D011933:Reagent Kits, Diagnostic; C008208:acarboxyprothrombin; D011516:Prothrombin