From the Guidelines
The primary tumor markers used for hepatocellular carcinoma (HCC) diagnosis and management are alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP, also known as PIVKA-II), and AFP-L3, with AFP being the most widely used marker, and levels above 200 ng/mL considered highly suspicious for HCC, as indicated by the most recent guidelines 1.
Key Points
- AFP is the most widely used marker, with levels above 200 ng/mL considered highly suspicious for HCC, though sensitivity is only about 60% as some tumors don't produce AFP 1.
- DCP is a protein induced by vitamin K absence or antagonism and offers complementary diagnostic value to AFP, with levels above 40 mAU/mL suggesting HCC 1.
- AFP-L3 is a fucosylated isoform of AFP that provides better specificity than total AFP, with levels above 10% of total AFP indicating malignancy 1.
- These markers are most effective when used in combination rather than individually, and serve not only for diagnosis but also for monitoring treatment response, detecting recurrence, and assessing prognosis 1.
- Regular monitoring of these markers (typically every 3-6 months) is recommended for patients with cirrhosis or other high-risk conditions, but tumor markers should not be used alone for diagnosis but rather in conjunction with imaging studies like ultrasound, CT, or MRI, as false positives can occur in conditions like chronic hepatitis and cirrhosis 1.
Diagnosis and Management
The diagnosis of HCC is based on the combination of clinical, laboratory, imaging, and pathology examinations, with imaging studies like ultrasound, CT, or MRI being essential for diagnostic confirmation and intrahepatic tumor staging 1.
Prognosis and Treatment
The prognosis of HCC is influenced by various factors, including tumor status, liver function, and general health status, with the Barcelona Clinic Liver Cancer (BCLC) staging system being a widely used and recommended system for prognostic classification and treatment allocation 1.
From the Research
Tumor Markers for Hepatocellular Carcinoma Diagnosis
- Alpha-fetoprotein (AFP) is the most widely used tumor marker for detecting hepatocellular carcinoma (HCC) 2, 3
- Other biomarkers, such as AFP-L3, DCP, osteopontin, and GP73, are also being evaluated for early detection of HCC 2, 4
- A combination of multiple markers can improve the accuracy of HCC diagnosis and provide a new strategy for prognosis and auxiliary diagnosis 4, 5
Serum Tumor Markers
- Serum tumor markers, including oncofetal antigens and glycoprotein antigens, enzymes and isoenzymes, genes, and cytokines, can be used for detecting HCC 3
- AFP, AFP-L3, and DCP are highly sensitive markers for HCC detection, with areas under the curve (AUC) values of 0.891,0.867, and 0.870, respectively 5
- The combination of AFP, AFP-L3, and DCP results in an AUC of 0.947, whereas the GALAD model shows an AUC of 0.976 5
Molecular Markers
- Specific molecular markers, such as hepatoma-specific gamma-glutamyl transpeptidase (HS-GGT), transforming growth factor (TGF)-beta1, and free insulin-like growth factor (IGF)-II, can be used for early diagnosis and monitoring metastasis or postoperative recurrence of HCC 6
- Circulating genetic markers, such as AFP-mRNA, TGF-beta1-mRNA, and IGF-II-mRNA, can be used to monitor distal metastasis or postoperative recurrence of HCC 6