Assessment of the Value of Mean Platelet Volume, Des Gamma Carboxy Prothrombin and Alpha Feto Protein in Early Detection of HCC

Abstract

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. AFP is the gold standard tumor marker for HCC, mean platelet volume (MPV) is a parameter obtained from complete blood count (CBC) by automated analyzers, shown to be increased in multiple malignancies and inflammatory conditions. This cross sectional comparative study was designed to evaluate the diagnostic usefulness of MPV as a diagnostic marker in HCC patients due to cirrhosis. Aim of the Work To determine the value of mean platelet volume, Des gamma Carboxy prothrombin and Alfa-feto protein in early detection of Hepatocelluler carcinoma Patients and Methods 105 patients were enrolled in this study, they were divided into 3 equal groups Group A: Hepatocelluler carcinoma patients (HCC) Group B: Liver cirrhosis patients Group C: Healthy Control group each is 35 patients. MPV, AFP, DCP were evaluated in all groups. Ultrasound and Triphasic CT. were also done to Group A&B to confirm or exclude the diagnosis of HCC and in group C as they are candidates for LDLT donors. Results Our results showed that regarding the diagnostic performance of the three tested tumor markers (AFP, MPV and DCP) in differentiating HCC from CLD groups that AFP had area under curve (AUC) of 0.719, Standard error (SE) of 0.061, Confidence interval (CI) of 0.599-0.839 and P value of 0.002 at a cut point of ≥ 40.0, MPV had area under curve (AUC) of 0.801, Standard error (SE) of 0.063, Confidence interval (CI) of 0.678 − 0.924 and P value of < 0.001 at a cut point of ≥ 10.2, while DCP had area under curve (AUC) of 0.842, Standard error (SE) of 0.047, Confidence interval (CI) of 0.750 − 0.935 and P value of < 0.001 at a cut point of ≥ 69.3 proving that DCP had the highest significant diagnostic performance in differentiating HCC from CLD groups also DCP≥ 69.3 had highest sensitivity(of 97.1%) and NPV(of 96.3%). AFP≥ 40.0 had highest specificity (of 91.4%) and PPV (of 86.4%). Youden’s index was highest in DCP ≥69.3, followed by MPV ≥10.2 and lowest in AFP ≥40.0. MPV had moderate sensitivity and specificity in between AFP and DCP with values of 71.4% and 85.7% respectively with also moderate PPV of 83.3 and NPV of 75% Conclusion Measurement of MPV is non-invasive, cheap and quick, and may therefore serve as a predictor of HCC in patients with CLD. Low sensitivity and specificity, on the other hand, suggests that this may be an adjunctive parameter to some other markers like AFP. Further studies with larger samples are needed to determine the association of MPV with HCC. For a single test DCP had highest significant diagnostic performance in differentiating HCC from CLD groups. In detection of HCC testing AFP≥ 40.0 if positive considered positive. If negative, retest for DCP≥ 69.3 if positive considered positive, otherwise is negative. This although deceased specificity and Positive predictive value, it raised sensitivity and Negative Predictive Value to 100.0% when combining both AFP and DCP. The benefit of increasing the sensitivity is not to miss cases with HCC while the decreased specificity and PPV can be compensated by further imaging studies to eliminate the false positive cases.