Suehiro T, Sugimachi K, Matsumata T, Itasaka H, Taketomi A, Maeda T
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Cancer. 1994 May 15;73(10):2464-71. doi: 10.1002/1097-0142(19940515)73:10<2464::aid-cncr2820731004>3.0.co;2-9.
Protein induced by vitamin K absence or antagonist II (PIVKA-II) was widely used as a diagnostic marker for hepatocellular carcinoma (HCC), however, its prognostic value is unclear. The authors evaluated PIVKA-II clinicopathologically as a prognostic marker for HCC.
The relationship between pathologic prognostic factors and plasma PIVKA-II and alpha-fetoprotein (AFP) was investigated in 72 patients with resectable HCC measuring less than 6 cm in greatest dimension.
PIVKA-II shows significantly lower sensitivity, but higher specificity than AFP, and the use of these two complementary markers appears to be useful in the diagnosis of HCC. The frequencies of intrahepatic metastasis, portal vein tumor thrombus, hepatic vein tumor thrombus, and capsular infiltration were significantly higher in patients with positive PIVKA-II than in those with negative-PIVKA-II, and the recurrence-free rate was significantly lower in patients with positive rather than with negative PIVKA-II. However, there were no significant differences between the patients who were AFP positive and those who were AFP negative in pathologic prognostic factors and the recurrence-free rate. From univariate and multivariate analyses, the authors find that PIVKA-II is one of the risk factors for recurrence of HCC after hepatectomy.
PIVKA-II may be a useful marker for the prediction of intrahepatic spread and for the prognosis of HCC. In addition, PIVKA-II-positive patients, thus, need aggressive postoperative adjuvant therapy for undetectable residual tumors and careful postoperative monitoring to enable the early recognition of recurrence.
维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）被广泛用作肝细胞癌（HCC）的诊断标志物，然而，其预后价值尚不清楚。作者通过临床病理评估PIVKA-II作为HCC的预后标志物。
对72例最大直径小于6 cm的可切除HCC患者，研究病理预后因素与血浆PIVKA-II和甲胎蛋白（AFP）之间的关系。
PIVKA-II的敏感性显著低于AFP，但特异性高于AFP，这两种互补标志物的联合使用似乎有助于HCC的诊断。PIVKA-II阳性患者的肝内转移、门静脉癌栓、肝静脉癌栓和包膜浸润的发生率显著高于PIVKA-II阴性患者，PIVKA-II阳性患者的无复发生存率显著低于阴性患者。然而，AFP阳性和AFP阴性患者在病理预后因素和无复发生存率方面没有显著差异。通过单因素和多因素分析，作者发现PIVKA-II是肝切除术后HCC复发的危险因素之一。
PIVKA-II可能是预测肝内扩散和HCC预后的有用标志物。此外，PIVKA-II阳性患者因此需要针对不可检测的残留肿瘤进行积极的术后辅助治疗，并进行仔细的术后监测，以便早期识别复发。
