title: Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma.
abstract: OBJECTIVE
  To clarify the effect of a high des-gamma-carboxy prothrombin (DCP) level on the invasiveness and prognosis of small hepatocellular carcinoma.
  
  
  METHODS
  Among 142 consecutive patients with known DCP levels, who underwent hepatectomy because of hepatocellular carcinoma, 85 patients met the criteria for small hepatocellular carcinoma, i.e. one<or=5 cm sized single tumor or no more than three<or=3 cm sized tumors.
  
  
  RESULTS
  The overall survival rate of the 142 patients was 92.1% for 1 year, 69.6% for 3 years, and 56.9% for 5 years. Multivariate analysis showed that microscopic vascular invasion (P=0.03) and serum DCP>or=400 mAU/mL (P=0.02) were independent prognostic factors. In the group of patients who met the criteria for small hepatocellular carcinoma, DCP>or=400 mAU/mL was found to be an independent prognostic factor for recurrence-free (P=0.02) and overall survival (P=0.0005). In patients who did not meet the criteria, the presence of vascular invasion was an independent factor for recurrence-free (P=0.02) and overall survivals (P=0.01). In 75% of patients with small hepatocellular carcinoma and high DCP levels, recurrence occurred extrahepatically.
  
  
  CONCLUSIONS
  For small hepatocellular carcinoma, a high preoperative DCP level appears indicative for tumor recurrence. Because many patients with a high preoperative DCP level develop extrahepatic recurrence, it is necessary to screen the whole body.
authors.affiliation: Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan. hakamada@cc.hirosaki-u.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hakamada
authors.forename: Norihisa
authors.initials: N
authors.lastname: Kimura
authors.forename: Takuya
authors.initials: T
authors.lastname: Miura
authors.forename: Hajime
authors.initials: H
authors.lastname: Morohashi
authors.forename: Keinosuke
authors.initials: K
authors.lastname: Ishido
authors.forename: Masaki
authors.initials: M
authors.lastname: Nara
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Toyoki
authors.forename: Shunji
authors.initials: S
authors.lastname: Narumi
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin