Frequency of elevated hepatocellular carcinoma (HCC) biomarkers in patients with advanced hepatitis C.

ABSTRACT: OBJECTIVES:Prospective studies of serum hepatocellular carcinoma (HCC) biomarkers in patients with advanced hepatitis C are lacking. The aim of this study was to determine the frequencies and performance of elevated ?-fetoprotein (AFP), AFP-L3, and des-?-carboxy prothrombin (DCP) levels as HCC biomarkers in advanced hepatitis C. METHODS:Patients in the HALT-C Trial were tested every 3 months for 42 months. Screening ultrasound was performed every 12 months. Levels of biomarkers were compared in patients in whom HCC did or did not develop. RESULTS:In all, 855 patients were evaluated; HCC developed in 46. Among patients without HCC, 73.2% had AFP consistently <20, 24.5% had at least one AFP between 20 and 199, and 2.3% had at least one AFP value ?200 ng/ml; 73.7% had DCP consistently <90, 11.6% had at least one DCP between 90 and 149, and 14.7% had at least one DCP value ?150 mAU/ml. AFP-L3 ?10% was present at least once in 9.0% and in 17.1% of those with AFP ?20 ng/ml. Among all patients with elevated biomarkers, a diagnosis of HCC was made in 0-31.6% (depending on the biomarker and cutoff) during the subsequent 24 months. AFP ?200 ng/ml had the highest specificity (99%), but sensitivity was ?20%. DCP ?40 mAU/ml had the highest sensitivity (76%), but specificity was ?58%. Independent predictors of elevated AFP were gender (female), race (Black), more advanced disease, and HCC. Elevated DCP was associated with more advanced disease and HCC. CONCLUSIONS:Mild-moderate elevations in total AFP and DCP but not in AFP-L3 occur frequently in patients with chronic hepatitis C and advanced fibrosis, are related to factors other than HCC, and are poor predictors of HCC.

SUBMITTER: Sterling RK 

PROVIDER: S-EPMC3903319 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature