The diagnostic value of PIVKA‐II, AFP, AFP‐L3, CEA, and their combinations in primary and metastatic hepatocellular carcinoma

Abstract

Background: Early diagnosis decreases the mortality of hepatocellular carcinoma (HCC). We aimed to investigate the usefulness of PIVKA-II, AFP, AFP-L3, CEA, and their combinations in the diagnosis of primary and metastatic HCC. Methods: One hundred and twenty patients with primary HCC (PHC), 115 with metastatic HCC (MHC), 89 with chronic liver disease (CLD), and 116 healthy volunteers were included. The diagnostic values of each marker and their combinations for HCC diagnosis were represented by ROC curve analyses.Results: PIVKA-II, AFP, and AFP-L3 levels in PHC group were higher than that in normal control, CLD, and MHC groups. CEA levels in MHC group were higher than that in the other three groups. When the four markers were analyzed individually, PIVKA-II showed the highest positive rate in PHC group (76.7%) and CEA showed the highest positive rate in MHC group (69.6%). PIVKA-II showed the largest area under ROC curve (AUC = 0.835) to discriminate PHC group from CLD group. Combined PIVKA-II with AFP-L3 increased the AUC to 0.910. CEA showed the highest AUC (0.849) to discriminate MHC group from CLD group. Combined CEA with PIVKA-II increased the AUC to 0.866. AFP-L3 alone showed the highest AUC (0.890) to discriminate MHC group from PHC group. Combined PIVKA-II with AFP-L3, and CEA increased the AUC to 0.957. Conclusion: PIVKA-II, AFP-L3, AFP, and CEA are effective biomarkers for the diagnosis of PHC and MHC. Their combinations could improve the diagnostic performance compared with each marker used alone in detecting PHC and MHC. K E Y W O R D S AFP, AFP-L3, CEA, hepatocellular carcinoma, PIVKA-II

Evaluation of serum alpha fetoprotein-L3 as an accuracy novel biomarker for the early diagnosis of hepatocellular carcinoma in Egyptian patients

“…The problem with AFP as a biomarker for HCC is that in up to 40% of HCC patients, AFP levels are normal, especially in the early stage of the disease ( Qi et al, 2019 ). Addition to the fact that several patients with benign liver diseases, such as gastrointestinal cancer, chronic hepatitis and liver cirrhosis also have elevated serum AFP ( Tsuchiya et al, 2015 , Omata et al, 2010 ) found that a significant percentage of small HCCs < 3 cm do not secrete AFP to reach a diagnostic level.…”

Progression of Prothrombin Induced by Vitamin K Absence-II in Hepatocellular Carcinoma

“…According to previous literature, serum levels of PIVKA-II>217 mAu/ml was an independent risk factor of early HCC recurrence (p = 0.0001) (114,115). Feng Gao et al reported that the cutoff value of PIVKA-II was 445 mAU/ml (RR=2.307, 95% CI: 1.132-4.703, P=0.021) (33). However, the association between low PIVKA-II levels and longer survival was weak (116).…”

“…The remaining Glu residues are called des-gcarboxy prothrombin. PIVKA-II contains less than 10 Gla residues, resulting in a deficiency of thrombogen synthesis (33). Hemker et al first observed the biosynthesis of PIVKA-II indirectly in 1963 (34).…”

SOX4 as biomarker in hepatitis B virus-associated hepatocellular carcinoma

“…Early detection and more effective management of liver cancer is therefore Ivyspring International Publisher necessary. While some HCC prognostic biomarkers have been recommended, such as α-fetoprotein (AFP) [4] and PIVKA-II [5], HCC survival is still poor. Better understanding of the mechanisms of HCC development and progression, as well as the identification of novel prognostic biomarkers is needed.…”