Des-γ-carboxy prothrombin and α-fetoprotein positive status as a new prognostic indicator after hepatic resection for hepatocellular carcinoma

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Abstract
BACKGROUND The aim of this study was to elucidate the usefulness of measuring the positive status of both des‐γ‐carboxy prothrombin (DCP) and α‐fetoprotein (AFP) preoperatively as a new prognostic indicator of hepatocellular carcinoma (HCC). METHODS One hundred forty‐seven patients who underwent curative hepatic resection for primary HCC were studied. The definitions of DCP and AFP positivity were: positive DCP > 0.1 AU/ml, and positive AFP > 50 ng/ml. The patients were classified into four groups according to their levels of positivity for DCP and/or AFP: Group 1 (n = 59), negative levels of both DCP and AFP; Group 2 (n = 28), negative DCP and positive AFP levels; Group 3 (n = 31), positive DCP and negative AFP levels; and Group 4 (n = 29), positive levels of both DCP and AFP. RESULTS Patient survival and disease free survival in Group 4 were the worst among the four groups. By multivariate analysis, using Cox proportional hazards model, both the DCP‐ and AFP‐positive status (in combination) and poorly differentiated histology were independent factors of poor prognosis for patient survival; and DCP‐ and AFP‐positive status (in combination), poorly differentiated histology, positive intrahepatic metastasis, and tumor diameter over 5 cm were independent factors of poor prognosis for disease free survival. CONCLUSIONS The combination of DCP‐ and AFP‐positive status is a new prognostic indicator for patients with HCC after hepatic resection. Cancer 1996;78:2094‐100.