Utility of four tumor markers, alone and in combination, for detection of hepatocellular carcinoma: AFP, AFP-L3, DCP, and Cystatin

4585 Background: α-Fetoprotein (AFP) is the most widely used biochemical marker for detection of hepatocellular cancer (HCC), but is also often elevated in non-malignant liver disease. Three other HCC markers have been identified: AFP-L3, des-gamma- carboxyprothrombin (DCP), and cystatin C. We explored the utility of using these markers, alone and in combination, for HCC detection. Method: All 4 markers were measured with commercial assays in serum samples from 60 patients with histologically confirmed HCC and 138 healthy adults of various ethnicities. Results: No positive results were obtained from the 138 healthy adults. As a single marker, AFP had the highest sensitivity for detecting HCC, followed by DCP, cystatin, and AFP-L3% (Table). The combination of AFP, DCP and cystatin C identified 70% of HCC cases with tumor size of <3 cm, and identified 92.5% of cases with tumors of >3 cm. When all cases were combined, the 3 marker panel identified 51 (85.0%) cases. Conclusion: These data suggest that the combination of AFP, DCP, and cystatin C yielded greater sensitivity for detecting HCC than 1) each marker alone, and 2) other combinations of these 4 markers. Further studies are underway to evaluate the utility of these combinations in distinguishing HCC from non-malignant hepatic disease. Table. Sensitivity of AFP, AFP-L3%, DCP, and Cystatin C as Markers of HCC in Patients with Histologically Confirmed HCC (N=60) Marker(s) Small tumor size (< 3cm, N=20) Large tumor size (> 3cm, N=40) Undefined tumor size (N=60) HCC Patients Sensitivity, % HCC Patients Sensitivity, % HCC Patients Sensitivity, % AFP+ 5 30.0 29 72.5 34.0 56.7 DCP+ 4 20.0 27 67.5 31.0 51.7 Cystatin C+ 9 45.0 21 55.0 30.0 50.0 AFP-L3+ 0 0.0 22 52.5 22.0 36.7 DCP+/AFP+ 9 45.0 35 87.5 44.0 73.3 DCP+/Cystatin C+ 10 50.0 34 85.0 44.0 58.3 AFP+/Cystatin C+ 13 65.0 35 87.5 48.0 80.0 DCP+/AFP+/ Cystatin C+ 14 70.0 37 92.5 51.0 85.0 DCP+/AFP+/AFP-L3+/ Cystatin C+ 14 70.0 37 92.5 51.0 85.0 No significant financial relationships to disclose.