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Test ID: DCP Des-Gamma-Carboxy Prothrombin, Serum

Reporting Name

Des-Gamma-Carboxy Prothrombin, S

Useful For

Risk assessment of patients with chronic liver disease for development of hepatocellular carcinoma (HCC)

 

Aiding in the monitoring of HCC patients post therapy if des-gamma-carboxy prothrombin (DCP) level was elevated prior to therapy

Specimen Type

Serum


Advisory Information


For diagnostic use, this test is most cost-effective for at-risk patients with normal levels of total and L3 alpha fetoprotein in serum. For more information see L3AFP / Alpha-Fetoprotein (AFP) L3% and Total, Hepatocellular Carcinoma Tumor Marker, Serum.



Specimen Required


Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL


Specimen Minimum Volume

0.2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Frozen (preferred) 90 days
  Refrigerated  7 days

Reference Values

<7.5 ng/mL

Day(s) and Time(s) Performed

Monday, Wednesday, Friday; 10 a.m.

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

83951

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DCP Des-Gamma-Carboxy Prothrombin, S 34444-0

 

Result ID Test Result Name Result LOINC Value
DCP Des-Gamma-Carboxy Prothrombin, S 34444-0

Clinical Information

Des-gamma-carboxy prothrombin (DCP), also known as the protein induced by vitamin K absence or antagonist II (PIVKA-II), is an abnormal form of the coagulation protein, prothrombin. DCP is a nonfunctional prothrombin resulting from a lack of carboxylation of 10 glutamic acid residues in the N-terminal portion of the molecule. In normal liver, prothrombin undergoes post-translational carboxylation before release into the peripheral blood. The carboxylation converts specific amino-terminal glutamic acid residues to gamma-carboxyglutamic acid. The vitamin K dependent carboxylase responsible for the carboxylation is absent in many hepatocellular carcinoma (HCC) cells, and an abnormal prothrombin with all or some of unconverted glutamic acid is secreted. Therefore, this noncarboxylated form (DCP) has been used as an HCC biomarker.

 

DCP is considered a complementary biomarker to alpha fetoprotein (AFP) and third electrophoretic form of lentil lectin-reactive AFP% (AFP-L3%) for assessing the risk of developing HCC. The elevation of both AFP-L3 and DCP indicate progression of HCC, albeit they reflect different features of the progression. In a prospective study of patients in the United States with an established diagnosis of HCC, the sensitivities for AFP, AFP-L3%, and DCP were 68%, 62%, and 73%, respectively. When the 3 markers were combined, the sensitivity was 86%. In another study, DCP levels were shown to correlate with tumor size and metastatic HCC. In this study, compared to AFP and AFP-L3%, DCP had the highest sensitivity (87%) and the highest positive predictive value (87%) in patients with HCC due to chronic hepatitis B and C infections. A number of studies have shown that elevated serum DCP is significantly related to portal vein invasion and/or intrahepatic metastasis, which significantly affect prognosis for patients with HCC.

 

DCP can be elevated in other conditions besides HCC. Conditions such as obstructive jaundice, intrahepatic cholestasis causing chronic decrease in vitamin K, and ingestion of drugs such as warfarin or wide-spectrum antibiotics can result in high concentrations of DCP. In addition, 25% to 50% of patients with HCC will have a DCP value within the reference range. Because of this, a normal DCP value does not rule out HCC.

Interpretation

In patients with an elevated des-gamma-carboxy prothrombin (DCP) result (≥7.5 ng/mL), the risk of developing hepatocellular carcinoma (HCC) is 36.5% (95% CI 23.5%-49.6%). The risk of developing HCC with a negative DCP result (<7.5 ng/mL) is 7.6% (95% CI 4.4%-10.8%).

 

For patients with HCC and an elevated DCP level prior to therapy, an elevated DCP level posttherapy is associated with an increased risk of HCC recurring.

Clinical Reference

1. Lai Q, Iesari S, Levi Sandri GB, Lerut J: Des-gamma-carboxy prothrombin in hepatocellular cancer patients waiting for liver transplant: a systematic review and meta-analysis. Int J Biol Markers. 2017 Oct 31;32(4):e370-e374. doi: 10.5301/ijbm.5000276

2. Zhu R, Yang J, Xu L, et al: Diagnostic Performance of Des-gamma-carboxy Prothrombin for Hepatocellular Carcinoma: A Meta-Analysis. Gastroenterol Res Pract. 2014;2014:529314. doi: 10.1155/2014/529314

3. De J, Shen Y, Qin J, et al: A Systematic Review of Des-gamma-Carboxy Prothrombin for the Diagnosis of Primary Hepatocellular Carcinoma. Medicine (Baltimore). 2016 Apr;95(17):e3448. doi: 10.1097/MD.0000000000003448

Analytic Time

Same day/1 day

Method Name

Isotachophoresis with Laser-Induced Fluorescence

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information:

mml-gi-liver-hcc