Caviglia Gian Paolo, Ribaldone Davide Giuseppe, Abate Maria Lorena, Ciancio Alessia, Pellicano Rinaldo, Smedile Antonina, Saracco Giorgio Maria
a Department of Medical Sciences , University of Turin , Turin , Italy.
b Unit of Gastroenterology and Hepatology , Città della Salute e della Scienza, Molinette Hospital , Turin , Italy.
Scand J Gastroenterol. 2018 Jun;53(6):734-740. doi: 10.1080/00365521.2018.1459824. Epub 2018 Apr 18.
In the setting of surveillance for hepatocellular carcinoma (HCC) detection, the use of serum biomarkers in addition to ultrasonography (US) is still a matter of debate. Hence, we performed a meta-analysis to evaluate the diagnostic accuracy of protein induced by vitamin K absence or antagonist-II (PIVKA-II) and alpha-fetoprotein (AFP) alone or in combination for HCC detection in patients at risk of tumor development.
We performed a systematic search in PubMed and Scopus database for original articles published in English from 2011 to 2017, investigating the accuracy of PIVKA-II alone or in combination with AFP (reported as area under the curve [AUC]) for HCC detection among patients at risk of tumor development. Furthermore, we focused on studies in which serum PIVKA-II was assessed by highly sensitive chemiluminescence immunoassay (CLEIA).
A total of 11 studies (873 patients with HCC and 1244 patients with advanced liver disease/cirrhosis) were included in the meta-analysis. The weighted summary AUC (sAUC) of PIVKA-II and AFP for the discrimination between patients with HCC and those without was 0.791 (0.746-0.837) and 0.767 (0.732-0.803), respectively. The combination of PIVKA-II + AFP results in a sAUC of 0.859 (0.837-0.882). The performance for HCC detection of PIVKA-II + AFP was significantly superior to each biomarker used alone (ΔsAUC = 0.068, p = .032 and ΔsAUC = 0.092, p < .001, respectively).
In clinical practice, the use of PIVKA-II + AFP in addition to US examination may improve the effectiveness of surveillance among patients at risk for HCC development.
在肝细胞癌（HCC）检测监测中，除超声检查（US）外，血清生物标志物的使用仍存在争议。因此，我们进行了一项荟萃分析，以评估维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）和甲胎蛋白（AFP）单独或联合用于检测有肿瘤发生风险患者的HCC的诊断准确性。
我们在PubMed和Scopus数据库中系统检索了2011年至2017年以英文发表的原始文章，研究单独使用PIVKA-II或与AFP联合使用（以曲线下面积[AUC]报告）在有肿瘤发生风险患者中检测HCC的准确性。此外，我们重点关注通过高灵敏度化学发光免疫分析（CLEIA）评估血清PIVKA-II的研究。
荟萃分析共纳入11项研究（873例HCC患者和1244例晚期肝病/肝硬化患者）。PIVKA-II和AFP用于区分HCC患者和非HCC患者的加权汇总AUC（sAUC）分别为0.791（0.746 - 0.837）和0.767（0.732 - 0.803）。PIVKA-II + AFP联合检测的sAUC为0.859（0.837 - 0.882）。PIVKA-II + AFP检测HCC的性能显著优于单独使用的每种生物标志物（ΔsAUC = 0.068，p = 0.032；ΔsAUC = 0.092，p < 0.001）。
在临床实践中，除US检查外，使用PIVKA-II + AFP可能会提高对有HCC发生风险患者监测的有效性。
