Diagnostic accuracy of des-gamma-carboxy prothrombin versus α-fetoprotein for hepatocellular carcinoma: A systematic review

Aims: Des-gamma-carboxy prothrombin (DCP) and alpha-fetoprotein (AFP) are useful tumor markers for the detection of hepatocellular carcinoma (HCC). However, it remains controversial whether the diagnostic accuracy of DCP is superior to AFP. The aims of this review were to compare the diagnostic accuracy of DCP, AFP and combination of both markers for detecting HCC and further compare their accuracy in diagnosing early stage HCC. Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE and Cochrane library until April 2013. Two authors independently assessed the methodological quality of each included study. Summary estimates of sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated. Results: Forty-nine studies involving 14 118 participants (including 1544 with early stage HCC) were included. In case of detection of HCC, the summary estimates of DCP were: sensitivity 63% (95% confidence interval [CI], 58%-67%), specificity 91% (95% CI, 88%-93%), and the values of AFP were: sensitivity 59% (95% CI, 54%-63%), specificity 86% (95% CI, 82%-89%). The AUROC of DCP, AFP and combination of both markers were 0.83, 0.77 and 0.88, respectively. Among the early stage HCC, the summary estimates of DCP and AFP were: sensitivity 45% (95% CI, 35%-57%) versus 48% (95% CI, 39%-57%), and specificity 95% (95% CI, 91%-97%) versus 89% (95% CI, 79%-95%). The AUROC was 0.84 for DCP, 0.68 for AFP and 0.83 for the combination of both markers. Conclusion: Des-gamma-carboxy prothrombin shows more diagnostic accuracy than AFP, especially in diagnosing early stage HCC, and the combination of both markers cannot improve the diagnostic accuracy of early stage HCC.