DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy.
Université Denis Diderot-Paris 7, Sorbonne Paris Cité, Paris.
Eur J Gastroenterol Hepatol. 2020 Oct;32(10):1364-1372. doi: 10.1097/MEG.0000000000001652.
We have confirmed the diagnostic value of protein induced by vitamin K absence or antagonist-II (PIVKA-II) in a French cohort of patients with hepatocellular carcinoma (HCC). Herein, we aim to study the biological response under treatment and the prognostic value of PIVKA-II serum level in patients treated for HCC.
Patients with primary HCC developed chronic liver disease with serum PIVKA-II, and alpha-fetoprotein (AFP) levels available at baseline and after first HCC treatment [within 3 months (M1-M3) and/or within 6-9 months (M6-M9)] were included.
A total of 94 patients were included. Median follow-up was 23 months (range 11-31 months). PIVKA-II levels significantly decreased from baseline to M1-M3 (P = 0.002) and to M6-M9 (P = 0.035). By multivariate analysis, biological response (M1-M3/baseline PIVKA-II ratio) independently and significantly predicted overall survival (OS). A ratio below 0.73 was able to identify patients with the better prognosis in the total population [OS: 27 months (range 17-31) vs. 17 (range 9-25); P = 0.008] and in patients who had transarterial chemoembolization or selective internal radiation therapy as first treatment approach [OS: 26 months (range 14-31) vs. 16 (range 9-25); P = 0.002 and 2-year OS of 73% vs. 30%; P = 0.009]. PIVKA-II serum levels at baseline and PIVKA-II biological response were significantly associated with radiological response.
PIVKA-II serum level seems to be a good prognostic and promising biomarker for early monitoring treatment outcomes for patients with HCC.
我们已经在法国肝细胞癌（HCC）患者队列中证实了维生素 K 缺乏或拮抗剂-II（PIVKA-II）蛋白的诊断价值。在此，我们旨在研究治疗下的生物学反应以及治疗 HCC 患者的 PIVKA-II 血清水平的预后价值。
纳入了患有原发性 HCC 的患者，这些患者患有慢性肝病，基线时有血清 PIVKA-II 和甲胎蛋白（AFP）水平，并且在首次 HCC 治疗后 1 个月内（M1-M3）和/或在 6-9 个月内（M6-M9）有这些水平。
共纳入 94 例患者。中位随访时间为 23 个月（范围 11-31 个月）。与基线相比，PIVKA-II 水平在 M1-M3（P=0.002）和 M6-M9（P=0.035）时显著降低。通过多变量分析，生物学反应（M1-M3/基线 PIVKA-II 比值）独立且显著预测了总生存（OS）。在总人群中，低于 0.73 的比值能够识别出预后更好的患者[OS：27 个月（范围 17-31）与 17 个月（范围 9-25）；P=0.008]，以及接受经动脉化疗栓塞或选择性内放射治疗作为一线治疗方法的患者[OS：26 个月（范围 14-31）与 16 个月（范围 9-25）；P=0.002，2 年 OS 为 73%与 30%；P=0.009]。基线时的 PIVKA-II 血清水平和 PIVKA-II 生物学反应与影像学反应显著相关。
PIVKA-II 血清水平似乎是 HCC 患者预后良好的生物标志物，并具有早期监测治疗效果的潜力。
