Diagnostic value of gamma-glutamyltransferase/aspartate aminotransferase ratio, protein induced by vitamin K absence or antagonist II, and alpha-fetoprotein in hepatitis B virus-related hepatocellular carcinoma

Table 1 Characteristics of the study population (n = 535)

Characteristic	CHB (n = 359)	HCC (n = 176)	P-value
Age (yr)	49 (39-59)	53 (47-62)	< 0.001
Gender (male: female)	281:78	152:24	0.025
PIVKA-II (mAU/mL)	22.88 (16.00-37.70)	4882.77 (274.98-30000)	< 0.001
AFP (ng/mL)	31.00 (5.30-126.00)	510.05 (25.91-9583.93)	< 0.001
γ-GT (U/L)	92.00 (47.50-160.70)	151.55 (68.10-346.20)	< 0.001
AST (U/L)	138.40 (56.00-367.00)	76.25 (44.25-131.75)	< 0.001
γ-GT/AST	0.58 (0.26-1.22)	1.84 (0.95-3.38)	< 0.001
HBV DNA+, n (%)	258 (71.87%)	88 (50.00%)	NA
Early-stage HCC, n (%)	NA	74 (42.05%)	NA

Data are expressed as the median (interquartile range) or number (%). CHB: Chronic hepatitis B; HCC: Hepatocellular carcinoma; PIVKA-II: Protein induced by vitamin K absence or antagonist II; AFP: Alpha-fetoprotein; γ-GT: Gamma-glutamyltransferase; AST: Aspartate aminotransferase; NA: Not applicable.

Table 2 Performance of protein induced by vitamin K absence or antagonist II, alpha-fetoprotein, and the ratio of gamma-glutamyltransferase to aspartate aminotransferase in early-stage hepatocellular carcinoma and hepatocellular carcinoma

	Early-stage HCC					HCC
	Cut-off	SEN (%)	SPE (%)	PPV (%)	NPV (%)	Cut-off	SEN (%)	SPE (%)	PPV (%)	NPV (%)
PIVKA-II (mAu/mL)	84.44	68.90	89.70	57.96	93.33	162.22	81.30	93.60	86.16	91.08
AFP (ng/mL)	145.65	47.30	77.20	29.95	87.66	145.65	64.80	77.20	58.22	81.73
γ-GT/AST	0.845	78.40	64.90	31.53	93.58	0.845	81.80	64.90	53.33	87.91
PIVKA-II + AFP	NA	60.80	90.80	57.67	91.83	NA	73.30	93.90	85.49	87.77
PIVKA-II + γ-GT/AST	NA	74.30	86.60	53.34	94.24	NA	86.90	83.80	72.45	92.88
AFP + γ-GT/AST	NA	56.80	81.90	39.28	90.19	NA	76.10	76.30	61.15	86.69
PIVKA-II + AFP + γ-GT/AST	NA	73.00	82.50	46.23	93.68	NA	78.40	91.10	81.20	89.59

HCC: Hepatocellular carcinoma; SEN: Sensitivity; SPE: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; PIVKA-II: Protein induced by vitamin K absence or antagonist II; AFP: Alpha-fetoprotein; γ-GT/AST: The ratio of gamma-glutamyltransferase to aspartate aminotransferase; NA: Not applicable.

Table 3 Performance of protein induced by vitamin K absence or antagonist II, alpha-fetoprotein, and the ratio of gamma-glutamyltransferase and aspartate aminotransferase in hepatitis B virus DNA+ and hepatitis B virus DNA- hepatocellular carcinoma patients

	HBV DNA+ HCC					HBV DNA- HCC
	Cut-off	SEN (%)	SPE (%)	PPV (%)	NPV (%)	Cut-off	SEN (%)	SPE (%)	PPV (%)	NPV (%)
PIVKA-II (mAu/mL)	84.44	92.00	92.60	80.92	97.14	154.92	72.70	91.10	87.68	79.30
AFP (ng/mL)	497.70	58.00	88.80	63.85	86.11	146.15	58.00	97.00	94.40	72.61
γ-GT/AST	0.640	88.60	60.50	43.34	93.96	0.830	85.20	52.50	60.98	80.28
PIVKA-II + AFP	NA	89.80	92.20	79.70	96.36	NA	80.70	87.10	84.50	83.82
PIVKA-II + γ-GT/AST	NA	89.80	92.60	80.54	96.38	NA	79.50	78.20	76.06	81.41
AFP + γ-GT/AST	NA	70.50	89.10	68.81	89.85	NA	75.00	78.20	74.98	78.21
PIVKA-II + AFP + γ-GT/AST	NA	90.90	92.20	79.90	96.74	NA	79.50	86.10	83.29	82.82

HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; SEN: Sensitivity; SPE: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; PIVKA-II: Protein induced by vitamin K absence or antagonist II; AFP: Alpha-fetoprotein; γ-GT/AST: The ratio of gamma-glutamyltransferase to aspartate aminotransferase; NA: Not applicable.