State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China.
Dis Markers. 2021 Feb 8;2021:8868370. doi: 10.1155/2021/8868370. eCollection 2021.
At present, the diagnostic accuracy of alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) surveillance is insufficient. It remains controversial whether prothrombin induced by vitamin K absence II (PIVKA-II) has a better diagnostic value than AFP for HCC patients.
To investigate the diagnostic role of PIVKA-II alone or in combination with AFP in Chinese HCC patients.
Serum AFP and PIVKA-II levels were detected and analyzed in 308 HCC afflicted patients and 120 unafflicted controls. The receiver operator curve (ROC) and area under the curve (AUC) were conducted to evaluate the clinical value of AFP and PIVKA-II for diagnosing HCC and early HCC.
In the whole HCC cohort, the diagnostic values of PIVKA-II were better than that of AFP. The AUC of PIVKA-II and AFP was 0.90 (95% CI 0.87-0.94) and 0.79 (95% CI 0.74-0.84), respectively. "AFP + PIVKA-II" yielded a high sensitivity of 95.1% and a specificity of 83.3%, with the AUC 0.89 (95% CI 0.85-0.93). In the early stage HCC group, the diagnostic accuracy of PIVKA-II was also better than that of AFP. The AUC of PIVKA-II and AFP was 0.83 (95% CI 0.77-0.89) and 0.75 (95% CI 0.68-0.81), respectively. "AFP + PIVKA-II" achieved the sensitivity of 83.3% and specificity of 89.1%, with an AUC of 0.86 (95% CI 0.81-0.91). Moreover, for AFP-negative HCC patients, serum PIVKA-II showed good diagnostic performance, with an AUC of 0.804 (95% CI 0.720-0.887). Besides, elevated PIVKA-II level was a strong independent risk factor for HCC patients with portal vein tumor thrombus (PVTT) (OR = 4.890, = 0.020).
PIVKA-II is superior to AFP in HCC screening, and AFP in combination with PIVKA-II significantly improves the diagnostic value for Chinese HCC patients. PIVKA-II could effectively indicate HCC accompanied by PVTT and help to optimize the therapeutic strategy.
目前，甲胎蛋白（AFP）对肝细胞癌（HCC）监测的诊断准确性不足。维生素 K 缺乏诱导的凝血酶原（PIVKA-II）是否比 AFP 对 HCC 患者具有更好的诊断价值仍存在争议。
探讨 PIVKA-II 单独或联合 AFP 对中国 HCC 患者的诊断价值。
检测并分析了 308 例 HCC 患者和 120 例非 HCC 对照者的血清 AFP 和 PIVKA-II 水平。采用受试者工作特征曲线（ROC）和曲线下面积（AUC）评估 AFP 和 PIVKA-II 对 HCC 和早期 HCC 的诊断价值。
在整个 HCC 队列中，PIVKA-II 的诊断价值优于 AFP。PIVKA-II 和 AFP 的 AUC 分别为 0.90（95%CI 0.87-0.94）和 0.79（95%CI 0.74-0.84）。“AFP+PIVKA-II”具有 95.1%的高灵敏度和 83.3%的特异性，AUC 为 0.89（95%CI 0.85-0.93）。在早期 HCC 组，PIVKA-II 的诊断准确性也优于 AFP。PIVKA-II 和 AFP 的 AUC 分别为 0.83（95%CI 0.77-0.89）和 0.75（95%CI 0.68-0.81）。“AFP+PIVKA-II”的灵敏度为 83.3%，特异性为 89.1%，AUC 为 0.86（95%CI 0.81-0.91）。此外，对于 AFP 阴性的 HCC 患者，血清 PIVKA-II 表现出良好的诊断性能，AUC 为 0.804（95%CI 0.720-0.887）。此外，升高的 PIVKA-II 水平是伴有门静脉癌栓（PVTT）的 HCC 患者的一个强独立危险因素（OR=4.890， =0.020）。
PIVKA-II 在 HCC 筛查中优于 AFP，联合 AFP 可显著提高中国 HCC 患者的诊断价值。PIVKA-II 可有效提示伴有 PVTT 的 HCC，并有助于优化治疗策略。
