Zhang Dongjing, Liu Zhihong, Yin Xueru, Qi Xiaolong, Lu Bingyun, Liu Yuanyuan, Hou Jinlin
1 Department of Hepatology Unit and Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
2 Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
Int J Biol Markers. 2018 Aug;33(3):266-274. doi: 10.1177/1724600818760234. Epub 2018 Apr 16.
Several studies have been conducted to evaluate the prognostic value of prothrombin induced by vitamin K absence-II (PIVKA-II) overexpression in hepatocellular carcinoma patients treated with curative ablation. However, the results remain controversial. The purpose of this meta-analysis was to explore the correlation between PIVKA-II expression and survival outcomes in these patients.
We performed a systematic literature search in PubMed, EMBASE, Medline, Cochrane Library, and Web of Science to identify the relevant articles investigating the prognostic value of PIVKA-II in patients with hepatocellular carcinoma. Combined hazard ratios (HR) and their 95% confidence intervals (CI) for overall survival and recurrence-free survival were calculated as the analysis endpoints.
A total of 15 cohorts encompassing 5647 patients were included. The results indicated that elevated PIVKA-II was significantly associated with poorer overall survival (HR 1.59; 95% CI 1.40, 1.82; P < 0.001) and recurrence-free survival (HR 1.76; 95% CI 1.42, 2.17; P < 0.001). Similar results were observed in the subgroup analysis based on sample size, analytical method, treatment modality, and cut-off value.
This meta-analysis suggests that elevated PIVKA-II is a predictor of unfavorable overall survival and recurrence-free survival in hepatocellular carcinoma patients receiving curative ablation. More rigorous studies are warranted to confirm the clinical utility of PIVKA-II in determining hepatocellular carcinoma prognosis.
已有多项研究评估维生素K缺乏诱导蛋白-II（PIVKA-II）过表达在接受根治性消融治疗的肝细胞癌患者中的预后价值。然而，结果仍存在争议。本荟萃分析的目的是探讨这些患者中PIVKA-II表达与生存结局之间的相关性。
我们在PubMed、EMBASE、Medline、Cochrane图书馆和科学网进行了系统的文献检索，以确定研究PIVKA-II在肝细胞癌患者中预后价值的相关文章。计算总生存和无复发生存的合并风险比（HR）及其95%置信区间（CI）作为分析终点。
共纳入15个队列，包含5647例患者。结果表明，PIVKA-II升高与较差的总生存（HR 1.59；95% CI 1.40, 1.82；P < 0.001）和无复发生存（HR 1.76；95% CI 1.42, 2.17；P < 0.001）显著相关。在基于样本量、分析方法、治疗方式和临界值的亚组分析中观察到类似结果。
本荟萃分析表明，PIVKA-II升高是接受根治性消融的肝细胞癌患者总生存和无复发生存不良的预测指标。需要更严格的研究来证实PIVKA-II在确定肝细胞癌预后中的临床实用性。
