Park M-S, Lee K-W, Kim H, Choi Y R, Hong G, Yi N-J, Suh K-S
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Transplant Proc. 2017 Jun;49(5):1109-1113. doi: 10.1016/j.transproceed.2017.03.017.
Prothrombin induced by the absence of vitamin K or antagonist-II (PIVKA-II) is a useful tumor marker for hepatocellular carcinoma (HCC). However, the usefulness of post-transplantation surveillance with PIVKA-II is not clear. We evaluated the clinical value of PIVKA-II in monitoring HCC recurrence after living-donor liver transplantation (LDLT).
One hundred twenty patients who had undergone LDLT for HCC from February 1999 to December 2010 and whose serum alpha-fetoprotein (AFP) and PIVKA-II had been measured sequentially before and after LDLT were included in this study. Patients were classified into four groups according to the preoperative level of AFP and PIVKA-II (group I, normal AFP and PIVKA-II; group II, elevated AFP; group III, elevated PIVKA-II; and group IV, elevated both AFP and PIVKA-II).
Preoperative PIVKA-II level tended to increase with increasing tumor size, number of nodules, presence of microvascular invasion, and poor differentiation. In 27 patients developing recurrent HCC after LDLT, the sensitivity of AFP and PIVKA-II was 59.2% and 88.8%, respectively. When the two markers were combined, the sensitivity increased to 92.5%. Especially, the sensitivity for PIVKA-II was high at groups I and III (100.0% for both, respectively). In patients in groups I, III, and IV, an elevated PIVKA-II level was the most common first sign of HCC recurrence after LDLT. An elevated PIVKA-II level was the most common first sign of recurrence, regardless of recurrence site.
PIVKA-II might be a useful tumor marker in the monitoring of recurrence after LDLT, complementary to AFP.
维生素K缺乏或拮抗剂-II诱导的凝血酶原（PIVKA-II）是肝细胞癌（HCC）的一种有用的肿瘤标志物。然而，移植后用PIVKA-II进行监测的实用性尚不清楚。我们评估了PIVKA-II在监测活体肝移植（LDLT）后HCC复发中的临床价值。
本研究纳入了1999年2月至2010年12月期间因HCC接受LDLT且在LDLT前后依次检测了血清甲胎蛋白（AFP）和PIVKA-II的120例患者。根据术前AFP和PIVKA-II水平将患者分为四组（I组，AFP和PIVKA-II正常；II组，AFP升高；III组，PIVKA-II升高；IV组，AFP和PIVKA-II均升高）。
术前PIVKA-II水平倾向于随着肿瘤大小增加、结节数量、微血管侵犯的存在以及分化差而升高。在27例LDLT后发生复发性HCC的患者中，AFP和PIVKA-II的敏感性分别为59.2%和88.8%。当两种标志物联合使用时，敏感性提高到92.5%。特别是，PIVKA-II在I组和III组中的敏感性较高（两组均为100.0%）。在I组、III组和IV组患者中，PIVKA-II水平升高是LDLT后HCC复发最常见的首发征象。无论复发部位如何，PIVKA-II水平升高是最常见的复发首发征象。
PIVKA-II可能是监测LDLT后复发的一种有用的肿瘤标志物，可作为AFP的补充。
