Des-gamma-carboxy prothrombin as a useful predisposing factor for the development of portal venous invasion in patients with hepatocellular carcinoma- A prospective analysis of 227 patients

BACKGROUND, Portal venous invasion (PVI) in patients with hepatocellular ca rcinoma (HCC) is an important factor affecting prognosis. The objective of this study was to elucidate predisposing factors for the development of PVI . METHODS. Two hundred twenty-seven patients with HCC who did not show PVI an d who received percutaneous ethanol injection therapy and/or microwave coag ulation therapy at the time of their first hospital admission were enrolled between 1994 and 1996 After their HCC was treated, the patients were follo wed for a mean of 19 months. For the detection of HCC recurrence and/or dev elopment of PVI, ultrasonography was performed every 3 months, a computed t omography (CT) scan was performed every 6 months, and the biochemical param eters of the patients were measured every month. PVI was defined as protrus ion of the tumor into the first and/or second branch or into the main trunk of the,nrtal vein. RESULTS. Of the 227 patients, 24 (11%) later developed PVI. Tabular analysi s was performed on these 24 patients and indicated that tumor size, albumin , total bilirubin, prothrombin time, alpha -fetoprotein (AFP) level, and de s-gamma -carboxy prothrombin (DCP) level differed significantly between the time of initial admission and the time of PVI development. A univariate an alysis performed on the 227 patients indicated that an increase in the numb ers of tumors, the histologic tumor grade (differentiation), the AFP level, and the DCP level at the time of initial diagnosis of HCC had a significan t correlation with the later development of PVI; and a stepwise, multivaria te Cox regression analysis revealed that the DCP level was the strongest pr edisposing factor (P < 0.0010; risk ratio = 5.65) followed by the histologi c grade of tumor differentiation. CONCLUSIONS, The results suggest that the serum DCP level is the most usefu l predisposing clinical parameter for the development of PVI. (C) 2001 Amer ican Cancer Society.