Department of Hepato-Pancreatic-biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Asian Pac J Cancer Prev. 2021 Jun 1;22(6):1731-1736. doi: 10.31557/APJCP.2021.22.6.1731.
Despite moderate sensitivity, alpha fetoprotein (AFP) is widely used in screening and prognostication for hepatocellular carcinoma (HCC). The objective of the current study was to assess clinical utility of Prothrombin induced by Vitamin K absence-II (PIVKAII) in addition to AFP in patients with HCC.
We retrospectively reviewed 244 patients with documented AFP, PIVKA II and dynamic imaging of the liver. Using ROC curves, cutoff values for AFP and PIVKAII for HCC detection, tumor grade and microvascular invasion (MVI) were assessed. In patients who underwent liver transplantation (LT) for HCC, survival was determined using Kaplan Meier curves.
The median PIVKAII in healthy living donors was 28.6mAU/ml (15.9-55). In cirrhotics, the sensitivity of an AFP cutoff of 7.6 ng/ml or PIVKAII cutoff of 250 mAU/ml for HCC detection was 91.7% (176/192) and specificity was 62.9%(68/108) (p <0.0001). In patients with HCC, PIVKAII values were significantly elevated with tumor size > 5 cm (P < 0.0001), tumor nodules > 3(P=0.01), and macrovascular invasion(p <0.0001). The high risk group (patients with AFP ≥ 40 ng/ml + PIVKAII ≥ 350 mAU/ml), had a sensitivity of (23/33) 69.6% and specificity of (22/22)100% for MVI (P <0.001). The estimated 3 year RFS after LT in the low risk group (AFP.
尽管甲胎蛋白（AFP）具有中等敏感性，但仍广泛用于肝细胞癌（HCC）的筛查和预后判断。本研究旨在评估除 AFP 以外，维生素 K 缺乏诱导的凝血酶原（PIVKAII）在 HCC 患者中的临床应用价值。
我们回顾性分析了 244 例记录有 AFP、PIVKA II 和肝脏动态影像学检查的患者。采用 ROC 曲线评估 AFP 和 PIVKA II 用于 HCC 检测、肿瘤分级和微血管侵犯（MVI）的截断值。对因 HCC 而行肝移植（LT）的患者，采用 Kaplan-Meier 曲线确定其生存情况。
健康供者的中位 PIVKAII 值为 28.6mAU/ml（15.9-55）。在肝硬化患者中，AFP 截断值为 7.6ng/ml 或 PIVKA II 截断值为 250mAU/ml 用于 HCC 检测的敏感性为 91.7%（176/192），特异性为 62.9%（68/108）（p<0.0001）。在 HCC 患者中，PIVKA II 值随着肿瘤直径>5cm（P<0.0001）、肿瘤结节>3 个（P=0.01）和大血管侵犯（p<0.0001）而显著升高。高风险组（AFP≥40ng/ml+PIVKA II≥350mAU/ml）的 MVI 敏感性为（23/33）69.6%，特异性为（22/22）100%（P<0.001）。低风险组（AFP
