Roles of AFP, AFP-L3, DCP and GP73 in Diagnosis of Hepatocellular Carcinoma and Prediction of Recurrence in Patients

Background: Alpha-fetoprotein (AFP), Des-gamma carboxy-prothrombin (DCP), lectin-bound AFP (AFP-L3) and Golgi protein-73 (GP73) have been used or proposed as surveillance tests for hepatocellular carcinoma (HCC). The aims of this study were to determine the performance of AFP, DCP, AFP-L3, GP73 and their combination in the diagnosis and prognosis of HCC. Methods: A total of 578 patients were enrolled, including 303 HCC patients, 104 patients with liver cirrhosis, 101 patients with chronic hepatitis and 70 healthy volunteers. The serum levels of AFP, DCP, AFP-L3 and GP73 were quantified before treatment, 7 days and 30 days after treatment. Results: AFP had the best area under the curve (AUC = 0.850), followed by DCP (0.775) and AFP-L3 (0.763), for the prediction of HCC, whereas GP73 had low diagnostic value (0.549). The combination of AFP, DCP and AFP-L3 significantly improved diagnostic performance (AUC = 0.895). The level of AFP 30 days after treatment had the best predictive value for HCC recurrence (AUC = 0.779). Higher recurrence rates were associated with an increasing number of elevated tumor markers measured both before and 30 days after treatment. Furthermore, patients whose marker status remained positive 30 days after treatment had a higher recurrence rate than patients whose marker status changed to negative. Conclusions: AFP was more effective than DCP and AFP-L3 for the diagnosis and prognosis of HCC, and the combination of AFP, AFP-L3 and DCP enhanced the diagnostic performance. The dynamic changes in biomarker positive status after treatment and the number of positive biomarkers play important roles in predicting HCC recurrence.