Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma
Kenichi Hakamada1, Norihisa Kimura, Takuya Miura
1Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan. hakamada@cc.hirosaki-u.ac.jp
Aim:
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
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.
Conclusion:
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.
