Post-ablation des-gamma-carboxy prothrombin level predicts prognosis in hepatitis B-related hepatocellular carcinoma

Background & Aims: We investigated whether pre- or post-ablation serum alpha-foetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) levels can predict prognosis in patients with curative radiofrequency ablation (RFA) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods: We retrospectively analysed 412 patients with HBV-related single HCC treated with percutaneous RFA between January 2004 and December 2013. AFP and DCP levels were measured before (pre-ablation) and 1 month after treatment (post-ablation). We assessed predictive factors for overall and recurrence-free survival. Results: On univariate analysis, Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, platelet count, tumour size, Barcelona Clinic Liver Cancer (BCLC) stage, and pre- and post-ablation DCP were significant for overall survival; and age, Child-Pugh score, MELD score, platelet count, tumour size, Cancer of the Liver Italian Program (CLIP) score, BCLC stage, and pre- and post-ablation AFP and DCP were significant for recurrence-free survival. Multivariate analysis revealed significant differences in overall survival by MELD score and tumour size and in recurrence-free survival by BCLC stage. Among the tumour markers, post-ablation DCP was an independent prognostic factor for overall and recurrence-free survival [hazard ratio (HR), 3.438; 95% confidence interval (CI), 1.331-8.877; P = 0.011 and HR, 4.934; 95% CI, 2.761-8.816; P < 0.001 respectively]. Post-ablation AFP was associated with recurrence-free survival (HR, 1.995; 95% CI, 1.476-2.697; P < 0.001) but not overall survival. Conclusions: In patients with HBV-related HCC, post-ablation serum DCP is a useful biomarker for predicting survival and recurrence after curative RFA.