## Des-Gamma-Carboxy Prothrombin (DCP) in HCC **Key Point:** DCP (also called PIVKA-II) is an abnormal prothrombin produced exclusively by hepatocellular carcinoma cells, making it more specific for HCC than AFP alone. ### Why DCP is Superior for HCC Specificity **High-Yield:** DCP is elevated in ~50% of HCC cases and is rarely elevated in benign liver disease or cirrhosis without malignancy. In contrast, AFP can be elevated in cirrhosis, chronic hepatitis B, and benign hepatic adenomas. ### Clinical Application **Clinical Pearl:** The combination of AFP + DCP has superior diagnostic accuracy for HCC compared to AFP alone. DCP elevation suggests active HCC rather than chronic liver disease. ### Comparison of HCC Tumor Markers | Marker | Sensitivity | Specificity | Utility | | --- | --- | --- | --- | | AFP | 60–70% | Moderate (↑ in cirrhosis) | Screening; less specific | | DCP (PIVKA-II) | 50–60% | High (HCC-specific) | Diagnosis; better specificity | | AFP + DCP | 80–85% | High | Combined use optimal | | CEA | Low | Low | Not useful for HCC | **Mnemonic:** **DCP = Diagnostic Clarity in HCC** — when AFP is borderline, DCP tips the diagnosis toward malignancy. [cite:Harrison 21e Ch 297] 
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