The Role of AFP-L3 and DCP Biomarkers in the Diagnosis and Management of Hepatocellular Carcinoma

Abstract Purpose of Review This review focuses on the emerging roles of AFP-L3 and DCP as complementary biomarkers to AFP in the diagnosis, management, and surveillance of hepatocellular carcinoma (HCC). We aim to provide a comprehensive overview of their utility in improving HCC outcomes, including early detection, risk stratification, treatment response, and post-transplant monitoring. Recent Findings AFP-L3 and DCP have demonstrated significant utility in augmenting AFP for HCC diagnosis and prognostication. The GALAD score, which integrates AFP, AFP-L3, and DCP, has shown superior sensitivity and specificity for early-stage HCC detection compared to AFP alone. Both biomarkers are predictive of aggressive tumor features, including microvascular invasion, and have shown promise in treatment response monitoring and post-transplant recurrence risk stratification. Emerging models like the LAD score have highlighted their potential to improve sensitivity for viable tumor detection post-treatment. Summary AFP-L3 and DCP represent critical advancements in biomarker-driven management of HCC, offering improved diagnostic accuracy and prognostic capabilities. Standardization of cutoff values and routine inclusion in national databases could enhance their clinical application. Ongoing trials, such as those comparing GALAD to traditional AFP and ultrasound screening, may establish these biomarkers as standard components of HCC management algorithms.