Division of Surgical Oncology and Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Anticancer Res. 2013 Jun;33(6):2689-97.
Although the protein-induced vitamin K absence or antagonist-II (PIVKA-II) is used as a prognostic marker in hepatocellular carcinoma (HCC), a newly-improved assay, NX-PVKA (PIVKA-II measured using P-11 and P-16 antibodies) and NX-PVKA-R (ratio of PIVKA-II and NX-PVKA), are more accurate markers of PIVKA-II. We conducted a prospectively preliminary analysis of the relationship between NX-PVKA-R and clinicopathological parameters and prognosis in 22 patients with HCC who underwent hepatectomy and measured changes of this marker's levels after treatment. Median value of PIVKA-II (80 mAU/ml), NX-PVKA (60 mAU/ml), NX-PVKA-R (1.5) and NX-PVKA-D (difference of markers, 15 mAU/ml) were determined. Tumor relapse was observed in six patients, and the one year relapse-free survival rate was 88%. Correlation between PIVKA-II or alpha-fetoprotein levels and NX-PVKA, NX-PVKA-R or -D levels was significant (p<0.001). NX-PVKA-R was significantly correlated with tumor size (p<0.05). In patients who underwent pre-treatment before hepatectomy, PIVKA-II, NX-PVKA and NX-PVKA-R tended to be higher than in patients without pre-treatment, but this difference was not significant (p>0.10). For macroscopic findings, NX-PVKA-R for the confluent-nodular type was significantly higher than that for the simple-nodular type (p<0.05). The tumor-free survival rate in the group with a high NX-PVKA-R was significantly lower than that in the group with a low NX-PVKA-R group (p<0.05). In patients with tumor recurrence, postoperative NX-PVKA-R increased again. We conclude that a high value of NX-PVKA-R after hepatectomy for HCC reflects malignant potential and predicts early recurrence in patients with HCC.
尽管蛋白诱导的维生素 K 缺乏或拮抗剂-II（PIVKA-II）被用作肝细胞癌（HCC）的预后标志物，但一种新的改良检测方法，NX-PVKA（使用 P-11 和 P-16 抗体测量的 PIVKA-II）和 NX-PVKA-R（PIVKA-II 和 NX-PVKA 的比值），是更准确的 PIVKA-II 标志物。我们对 22 例接受肝切除术的 HCC 患者进行了前瞻性初步分析，研究了 NX-PVKA-R 与临床病理参数和预后之间的关系，并测量了治疗后该标志物水平的变化。确定了 PIVKA-II（80mAU/ml）、NX-PVKA（60mAU/ml）、NX-PVKA-R（1.5）和 NX-PVKA-D（标志物差异，15mAU/ml）的中位数。6 例患者出现肿瘤复发，1 年无复发生存率为 88%。PIVKA-II 或甲胎蛋白水平与 NX-PVKA、NX-PVKA-R 或-D 水平之间存在显著相关性（p<0.001）。NX-PVKA-R 与肿瘤大小显著相关（p<0.05）。在接受肝切除术前接受治疗的患者中，PIVKA-II、NX-PVKA 和 NX-PVKA-R 倾向于高于未接受治疗的患者，但差异无统计学意义（p>0.10）。对于宏观发现，融合性结节型的 NX-PVKA-R 明显高于单纯结节型（p<0.05）。高 NX-PVKA-R 组的无瘤生存率明显低于低 NX-PVKA-R 组（p<0.05）。在肿瘤复发的患者中，术后 NX-PVKA-R 再次升高。我们得出结论，HCC 肝切除术后 NX-PVKA-R 升高值反映了恶性潜能，并预测 HCC 患者的早期复发。
