DKK1 was more accurate than the most
commonly tested marker
Hugo Wilcken
A newly tested serum protein marker for hepatocellular carcinoma (HCC) could improve early diagnosis and better distinguish HCC from non-malignant chronic liver diseases, say Chinese researchers.
Dickkopf-1 (DKK1) – a secretory antagonist of the WNT pathway – was more diagnostically accurate across a range of scenarios than the most widely tested biomarker for HCC, alpha-Fetoprotein (AFP), a retrospective study involving nearly 1,300 participants found.
DKK1 maintained diagnostic accuracy for patients with early-stage HCC as well as for AFP-negative disease, which was important since 30-40% of all HCC patients were AFP-negative, the investigators said.
Reporting in The Lancet Oncology, the authors wrote that raised concentrations of DKK1 in serum could differentiate HCC from both chronic hepatitis B virus (HBV) infection and liver cirrhosis, which AFP was unable to do. In all scenarios, DKK1 alone or together with AFP was better than AFP alone.
“Our results indicate that serum DKK1 could potentially be used to diagnose HCC, especially early-stage disease, and will help to resolve the deficiencies of AFP-negative patients, and can be used to make differential diagnoses,” the authors concluded.
However in an accompanying editorial, two Spanish experts said although DKK1 showed promise, there was still a long way to go before it could be used as a diagnostic tool.
They noted the specificity of DKK1 was 85-90% whereas almost 100% was needed in oncology – although it might be acceptable for surveillance where high sensitivity was preferred to high specificity to avoid excessive false-negative rates.
Until further data were available, “practice guidelines should continue to state that tumour markers cannot be recommended for surveillance or diagnosis of liver cancer,” the researchers cautioned.
The Lancet Oncology 2012; doi: 10.1016/S1470-2045(12)70233-4; 10.1016/S1470-2045(12)70271-1
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