title: Des-γ carboxyprothrombin may not be a good biomarker for hepatocellular carcinoma in those chronically infected with hepatitis B virus with basal core promoter double mutations (T^{1762}, A^{1764}), a prospective study.
abstract: BACKGROUND
  The accuracy of des-γ -carboxyprothrombin (DCP) in the detection of hepatocellular carcinoma (HCC) in those infected hepatitis B virus (HBV) from cross-sectional or case-control studies is contradictory.
  
  
  OBJECTIVE
  To resolve this contradiction using a prospective study.
  
  
  METHODS
  Three hundred male individuals persistently infected with HBV were recruited from the Chinese cohort and followed up once per year from 2012 to 2015. Each subject was screened for HCC by measurements of serum alpha-fetoprotein (AFP), lectin-bound α -fetoprotein (AFP-L3), DCP concentrations and ultrasonographic examinations.
  
  
  RESULTS
  Nineteen HCC cases were identified. The area under receiver operating characteristic (AUROC) at first, second and third visit for AFP, AFP-L3 and DCP ranges from 0.710-0.897, 0.566-0.637 and 0.520-0.595, respectively. The rate of elevated DCP is not significantly different between the HCC cases and controls (52.6% vs. 47.4%) (P > 0.05). The incidence of HCC in subjects with elevated DCP is not significantly higher than that of those with normal DCP (9.5% vs. 4.6%) (P > 0.05). The AUROC of combinations of these biomarkers was higher than that of AFP alone at the first visit. However, it was reduced at the second visit. At the third visit, the AUROCs of AFP + DCP and AFP + AFP-L3 + DCP, but not that of AFP + AFP-L3, were higher than that of AFP alone.
  
  
  CONCLUSIONS
  AFP but DCP or AFP-L3 remains a valuable biomarker for HCC in those chronically infected with HBV. The combination with AFP-L3 and DCP may not increase the accuracy of AFP in differentiating HCC cases from controls, among those infected with HBV.
authors.affiliation: Department of Public Health of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China.
authors.forename: Guo-Jian
authors.initials: GJ
authors.lastname: Li
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.
authors.forename: Qin-Yan
authors.initials: QY
authors.lastname: Chen
authors.affiliation: Division of Medicine, UCL Medical School, London, UK.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Harrison
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.
authors.forename: Xue-Yan
authors.initials: XY
authors.lastname: Wang
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.|School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Hu
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.
authors.forename: Qing-Li
authors.initials: QL
authors.lastname: Yang
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.|School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China.
authors.forename: Kai-Wen
authors.initials: KW
authors.lastname: Li
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.
authors.forename: Zhong-Liao
authors.initials: ZL
authors.lastname: Fang
mesh_terms: D000328:Adult; D000483:Alleles; D015415:Biomarkers; D014408:Biomarkers, Tumor; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D011401:Promoter Regions, Genetic; D011498:Protein Precursors / Q000235:genetics*; D011516:Prothrombin / Q000235:genetics*; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: Hepatocellular carcinoma; hepatitis B virus; serum biomarker; the area under receiver operating characteristic