Protein induced by vitamin K absence or antagonist II as a prognostic marker in hepatocellular carcinoma. Comparison with alpha-fetoprotein

Abstract

Background. Protein induced by vitamin K absence or antagonist II (PIVKA‐II) was widely used as a diagnostic marker for hepatocellular carcinoma (HCC), however, its prognostic value is unclear. The authors evaluated PIVKA‐II clinicopathologically as a prognostic marker for HCC. Methods. The relationship between pathologic prognostic factors and plasma PIVKA‐II and alpha‐fetoprotein (AFP) was investigated in 72 patients with resectable HCC measuring less than 6 cm in greatest dimension. Results. PIVKA‐II shows significantly lower sensitivity, but higher specificity than AFP, and the use of these two complementary markers appears to be useful in the diagnosis of HCC. The frequencies of intrahepatic metastasis, portal vein tumor thrombus, hepatic vein tumor thrombus, and capsular infiltration were significantly higher in patients with positive PIVKA‐II than in those with negative‐PIVKA‐II, and the recurrence‐free rate was significantly lower in patients with positive rather than with negative PIVKA‐II. However, there were no significant differences between the patients who were AFP positive and those who were AFP negative in pathologic prognostic factors and the recurrence‐free rate. From univariate and multivariate analyses, the authors find that PIVKA‐II is one of the risk factors for recurrence of HCC after hepatectomy. Conclusions. PIVKA‐II may be a useful marker for the prediction of intrahepatic spread and for the prognosis of HCC. In addition, PIVKA‐II‐positive patients, thus, need aggressive postoperative adjuvant therapy for undetectable residual tumors and careful postoperative monitoring to enable the early recognition of recurrence.

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

“…Finally, 17 articles were included in our study (Fig. 1, Table 1) [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84]. Eleven studies included data on more than one tumor marker [70, 71, 73-77, 79-81, 83], and 4 of them provided sensitivity and specificity of a combination of two tumor markers [70,74,77,79].…”

Management of Hepatocellular Carcinoma *

“…121,[123][124][125][126] Most reports on the use of DGCP have evaluated the use of this test in a diagnostic mode, rather than for surveillance. Although there are reports of its use in a surveillance mode, these do not yet provide sufficient justification for routine use of this marker.…”

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…Furthermore, the level of AFP is elevated in patients with both HCC and chronic liver disease; thus, there is wide overlapping between the two groups [144,145]. Most studies adopt a cutoff value of 20 ng/mL for AFP, with a sensitivity ranging from 49 to 71% and specificity from 49 to 86% in HCCs smaller than 5 cm [146][147][148][149][150][151][152][153][154]. Limitations in the sensitivity and specificity of AFP in surveillance of high-risk populations have led to the use of US as an additional method for the detection of HCC [142,[155][156][157].…”