Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3928-3935
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3928
Diagnostic value of PIVKA-II and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma
Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Doo Jin Kim, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Joo Seop Kim, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park
Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea
Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Doo Jin Kim, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Joo Seop Kim, Hak Yang Kim, Digestive Disease Center, Hallym University Medical Center, Seoul 134-701, South Korea
Doo Jin Kim, Joo Seop Kim, Department of Surgery, Hallym University Medical Center, Seoul 134-701, South Korea
Author contributions: Seo SI designed study concept, performed analysis and interpretation of data and drafted the manuscript; Kim WJ, Shin WG, Kim DJ and Kim KH collected data; Jang MK, Lee JH and Kim JS performed statistical analysis and provided technical and material support; Kim HY, Kim DJ, Lee MS and Park CK revised the important intellectual content of manuscript; Kim HS performed study design and supervision.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Hyoung Su Kim, Department of Internal Medicine, Hallym University Medical Center, 445 Gildong, Kangdong-gu, Seoul 134-701, South Korea. hskim@hallym.or.kr
Telephone: +82-2-22252889 Fax: +82-2-4786925
Received: August 13, 2014
Peer-review started: August 13, 2014
First decision: September 15, 2014
Revised: October 10, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
Abstract

AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) in chronic hepatitis B (CHB).

METHODS: A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma (HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic (AUROC) curves of PIVKA-II, AFP and their combination were calculated and compared.

RESULTS: The optimal cutoff values for PIVKA-II and AFP were 40 mAU/mL and 10 ng/mL, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-II and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-II and AFP were not significantly different (0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-II was significantly better than that of AFP in patients with cirrhosis (0.870 vs 0.812, P = 0.042). When PIVKA-II and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-II alone for the differentiation of HCC from nonmalignant CHB (P < 0.05), especially when cirrhosis was present (P < 0.05).

CONCLUSION: Serum PIVKA-II might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.

Keywords: Hepatitis B virus, Hepatocellular carcinoma, Alpha-fetoprotein, Prothrombin induced by vitamin K absence-II

Core tip: Hepatocellular carcinoma (HCC) surveillance is crucial for patients with chronic hepatitis B (CHB). There have been few studies that have compared the levels of prothrombin induced by vitamin K absence-II (PIVKA-II) and AFP in hepatitis B virus-associated HCC. Serum PIVKA-II, at a level of 40 mAU/mL, is a useful tumor marker to distinguish patients with HCC from those with nonmalignant CHB, especially liver cirrhosis (LC). A combination of AFP and PIVKA-II could enhance early detection of HCC in patients with CHB. Therefore, serum PIVKA-II levels should be measured in combination with serum AFP levels during the follow-up of patients with CHB and particularly those with LC.