Unique clinical characteristics of patients with hepatocellular carcinoma who present with high plasma des-gamma-carboxy prothrombin and low serum alpha-fetoprotein

BACKGROUND, Although the importance of or-fetoprotein (AFP) and des-gamma-c arboxy prothrombin (DCP) in the clinical treatment of hepatocellular carcin oma (HCC) has been studied extensively, the authors examined the clinical p icture of HCC with regard to the state of these two tumor markers. AFP leve ls, high levels of both tumor markers, and low levels of both tumor markers . METHODS. The authors categorized 237 HCC cases into 4 groups according to l evels of AFP and DCP: high levels of AFP with low DCP levels, high DCP leve ls with low Comparisons of survival rates were made among these groups usin g the Kaplan-Meier product limit method, and for other comparisons of clini cal parameters the Fisher PSLD test was used. Prognostic significance was t ested with the Cox proportional hazards model. RESULTS. The cutoff values were set at 100 ng/mL for AFP and 0.0625 AU/mL f or DCP. Forty-eight patients (20.7%) had high levels of AFP and low levels of DCP, 22 (9.3%) had high DCP levels and low levels of AFP, 12 (4.6%) had high levels of both AFP and DCP, and 155 (65.4%) had low levels of both DCP and AFP. Patients with high levels of DCP but low levels of AFP were predo minantly male and had large lesions but few nodules. Patients with high lev els of both tumor markers had the most discouraging outcome observed in thi s study (death within 3 years). CONCLUSIONS, Patients with high levels of DCP and low levels of AFP exhibit ed the unique clinical characteristic of large HCC nodules that were few in number. In addition, it was observed that measurement of both AFP and DCP can predict the survival of patients. (C) 2000 American Cancer Society.