HCC Biomarkers

AFP-L3 and DCP

DCP (PIVKA-II) Test
A Complementary Biomarker for HCC

FDA Cleared and CMS Reimbursed

DCP (Des-gamma-carboxy prothrombin), also known as PIVKA-II (proteins induced by vitamin K absence or antagonist-II) is an abnormal form of the coagulation protein, prothrombin. The prothrombin precursor undergoes post-translational carboxylation in the liver prior to secretion into plasma. Many HCCs lack the responsible carboxylase and these HCC cells instead secrete the unmodified precursor, DCP. DCP lacks thrombotic activity and has been shown in multiple studies to be present in the serum of patients with HCC. AFP and DCP are different and independent tools for the risk assessment, surveillance and detection of HCC.

DCP (PIVKA-II) Molecule

DCP was first discovered as a novel serum marker for HCC in 1984 [1]. Subsequent studies have demonstrated the clinical utility of DCP in HCC detection [2-5]. A 2007 study by University of Michigan, an associate member of the EDRN (Early Detection Research Network) showed that DCP was highly sensitive (92%) and specific (93%) in differentiating early HCC from cirrhosis [6]. DCP also identified 15 of 17 HCC patients who would have been missed with AFP alone [6].

A 2008 study published by UCLA showed that DCP should be used as a main tool for HCC surveillance. DCP had the highest sensitivity of 87%, while scoring high specificity and PPV of 85%, respectively [7]. Furthermore, DCP had a direct correlation with tumor size, and was not elevated in any patients without HCC.

Patients who test positive for DCP often show features of HCC that are different from those who test positive for AFP-L3; elevated DCP level corresponds to advanced tumor characteristics and poor patient outcome [8-10].

References

  1. NEJM1984:310(22); 1427-1431.
  2. Anticancer Research, 1999; 19:2489-2494
  3. World J Gastroenterol 2005 Oct 21; 11(39):6115-9.
  4. Am J Gastroenterol 2006; 101:2038-2043.
  5. Hepatology 2003; 37:1114-1121.
  6. Cancer Biomarkers 2007; 3:79-87.
  7. J Gastroenterol Hepatol. 2008 Apr 19.
  8. Dig Dis Sci 2007;52:776-782.
  9. Clin Gastroenterol and Hepatol 2006;4:111-117.
  10. Cancer. 2001;91:561-569.