Clinical Utility of Des-γ-Carboxy Prothrombin Kinetics as a Complement to Radiologic Response in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Purpose: Serial alpha-fetoprotein (A FP) measurements are useful for assessing tumor responses to numerous therapies for hepatocellular carcinoma (HCC). This study tested the predictive value of changes in des-gamma-carboxy prothrombin (DCP), in parallel with AFP, as an indicator of HCC response after transarterial chemoembolization. Materials and Methods: The study group consisted of 327 patients with HCC initially seropositive for DCP (>= 40 mAU/mL) and/or AFP (>= 100 ng/mL) who underwent repeated chemoembolization as first-line therapy. Radio logic responses were measured based on modified Response Evaluation Criteria In Solid Tumors guidelines. Serologic response was defined as a decrease of at least 50% in DCP or AFP level from baseline. Radio logic serologic correlation and disease progression and survival according to serologic responses were analyzed. Results: Before treatment, 129 patients (39%) had high DCP alone, 66 (20%) had high AFP alone, and 58 (18%) had high levels of both. Radio logic and serologic responses were achieved in 88.2% and 91.4% of patients with high DCP levels and in 89.5% and 91.1% of those with high AFP levels, respectively. Serologic response based on AFP or DCP was significantly correlated with radiologic response, and this was confirmed by landmark analysis (P < .001). DCP and AFP responders had better times to progression and overall survival than nonresponders (P < .001). Cox models revealed that both serologic responses were independent estimates of survival (hazard ratios, 0.11 for DCP and 0.14 for AFP; P < .001). Conclusions: After transarterial chemoembolization for HCC, DCP response may be a useful surrogate endpoint of immediate and prolonged clinical outcomes, along with AFP response.