Predictive value of protein induced by absence of vitamin K absence or antagonist II, alpha-fetoprotein and gamma-glutamyltransferase/aspartate aminotransferase ratio for the diagnosis of hepatocellular carcinoma in transplantation candidates

Abstract

Objectives Alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) are used as tumour markers for the diagnosis of hepatocellular carcinoma (HCC). We investigate whether combined liver function marker such as gamma-glutamyl transferase (GGT) and aspartate aminotransferase (AST) with alpha-fetoprotein (AFP) and PIVKA-II increase their diagnostic predictive value in diagnosis of HCC. Methods The serum levels of PIVKA-II, AFP and GGT/AST ratio were analysed in 112 transplant candidates. Of these patients, 66 (59%) had HCC and 46 (41%) patients did not. Results Histological grade was positively correlated with serum levels of PIVKA-II and AFP (r = 0.255, P < 0.039 and r = 0.284, P < 0.021, respectively) and only tumour size positively correlated with the serum level of PIVKA-II (r = 0.270, P < 0.028), but no correlation between the number of tumour, Milan criteria and PIVKA-II (r = −0.002, P = 0.984 and r = 0.154, P = 0.216, respectively) with AFP (r = −0.024, P = 0.851 and r = 0.080, P = 0.522, respectively). Sensitivity and specificity of AFP, PIVKA-II and GGT/AST ratio at cutoff values of 6.08, 2.63 and 0.89, respectively, were as follows: 77, 77 vs 71, 83 vs 60 and 53%. The combination of AFP and PIVKA-II and GGT/AST ratio in HCC diagnosis increased AUROC values as follows; 0.860 vs 0.882 and 0.823 vs 0.840, respectively. Conclusions This study showed that combined tumour markers such as AFP, PIVKA-II and GGT/AST ratio increase their sensitivity in HCC diagnosis.

Predictive value of PIVKA-II and AFP for the non-objective response of HBV-associated hepatocellular carcinoma after transarterial chemoembolization: a prospective study

“…According to the results of the Spearman correlation analysis, there was no clear relationship between PIVKA-II and AFP in this study. Nevertheless, there was a complementary relationship consistent across studies, demonstrating that the combination of these two can overcome the limitations of the single marker in diagnosis [29][30][31][32]. Moreover, this study suggested that the combination of the two markers can help timely further management of relapsed or new patients and improve the survival rate of patients [33,34].…”

Gamma-glutamyl Transferase to Aspartate Aminotransferase Ratio (GSR) Predicts Prognoses in Patients with Colorectal Cancer with Liver Metastasis after Microwave Ablation

“…Although the relevant mechanisms have not been biologically validated, some previous studies have employed AST to eliminate the background effects of pancreatic and liver tumors [18,22,26]. We speculate that this phenomenon may occur because serum AST is released into the bloodstream in response to hepatocellular injury [25], and is more re ective of hepatocellular injury and less affected by tumor load.…”

“…Previous studies have reported that combining AST levels improves the predictive performance of hepatocellular carcinoma prediction models. [22,23]. Although the mechanism of the prognostic impact of these enzymes has not been fully elucidated, they may re ect the prognosis of hepatic tumor treatment to some extent.…”

Exploring the clinical value of preoperative serum gamma-glutamyl transferase levels in the management of patients with hepatocellular carcinoma receiving postoperative adjuvant transarterial chemoembolization

“…γ-GT is an emerging biomarker for HCC early detection and prognosis prediction [25,26], but its clinical value is far from being applied. In the current study, we found that elevated preoperative γ-GT was associated with worse OS and DFS, and was also correlated with aggressive tumor characteristics and increasing risk of intraoperative transfusion.…”