异常凝血酶原或甲胎蛋白在高危患者的肝细胞癌诊断中具有更好的诊断特性。
PIVKA-II or AFP has better diagnostic properties for hepatocellular carcinoma diagnosis in high-risk patients.
作者信息
Suttichaimongkol Tanita, Mitpracha Manoon, Tangvoraphonkchai Kawin, Sadee Phuangphaka, Sawanyawisuth Kittisak, Sukeepaisarnjaroen Wattana
机构信息
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand.
Division of Gastroenterology, Department of Medicine, Khon Kaen Regional Hospital, Khon Kaen - Thailand.
出版信息
J Circ Biomark. 2023 Feb 17;12:12-16. doi: 10.33393/jcb.2023.2453. eCollection 2023 Jan-Dec.
BACKGROUND
Hepatocellular carcinoma (HCC) is a lethal cancer. Two biomarkers were used for HCC diagnosis including alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II or antagonist (PIVKA-II). However, data on biomarkers and HCC diagnosis are not consistent. This study aimed to evaluate if PIVKA-II, AFP, or a combination of both biomarkers had the best diagnostic properties for HCC.
METHODS
This was a prospective study and enrolled patients 18 years or over with a high risk for HCC. AFP and PIVKA-II levels were calculated for HCC diagnosis. Diagnostic properties of both biomarkers were reported with sensitivity, specificity, and a receiver operating characteristic (ROC) curve.
RESULTS
There were 260 patients with high risk for HCC in this cohort. Of those, 219 patients were diagnosed with HCC: confirmed by biopsy in 7 patients (2.69%) and by imaging in the others. Median values of AFP and PIVKA-II were 56 ng/mL and 348 mAU/mL, respectively. PIVKA-II level of 40 mAU/mL had sensitivity of 80.80%, while AFP of 10 ng/mL had sensitivity of 75.80%. A combination of PIVKA-II at 100 mAU/mL or over and AFP of 11 ng/mL gave sensitivity of 60.30%. The ROC curve of PIVKA-II plus AFP was significantly higher than the AFP alone (0.855 vs. 0.796; p = 0.027), but not significantly different from the PIVKA-II alone (0.855 vs. 0.832; p = 0.130).
CONCLUSION
PIVKA-II may have more diagnostic yield for HCC compared with AFP. It can be used alone without a combination with AFP.
背景
肝细胞癌（HCC）是一种致命性癌症。两种生物标志物被用于HCC诊断，包括甲胎蛋白（AFP）和维生素K缺乏诱导蛋白-II或拮抗剂（PIVKA-II）。然而，关于生物标志物与HCC诊断的数据并不一致。本研究旨在评估PIVKA-II、AFP或这两种生物标志物的组合是否对HCC具有最佳诊断性能。
方法
这是一项前瞻性研究，纳入了18岁及以上的HCC高危患者。计算AFP和PIVKA-II水平以用于HCC诊断。报告了两种生物标志物的诊断性能，包括敏感性、特异性和受试者工作特征（ROC）曲线。
结果
该队列中有260例HCC高危患者。其中，219例患者被诊断为HCC：7例（2.69%）经活检确诊，其余经影像学确诊。AFP和PIVKA-II的中位数分别为56 ng/mL和348 mAU/mL。PIVKA-II水平为40 mAU/mL时敏感性为80.80%，而AFP为10 ng/mL时敏感性为75.80%。PIVKA-II为100 mAU/mL及以上且AFP为11 ng/mL的组合敏感性为60.30%。PIVKA-II加AFP的ROC曲线显著高于单独的AFP（0.855对0.796；p = 0.027），但与单独的PIVKA-II无显著差异（0.855对0.832；p = 0.130）。
结论
与AFP相比，PIVKA-II对HCC可能具有更高的诊断价值。它可以单独使用，无需与AFP联合。
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