Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Real impact of tumor marker AFP and PIVKA-II in detecting very small hepatocellular carcinoma (≤ 2 cm, Barcelona stage 0) - assessment with large number of cases
Kazuo Tarao, Akito Nozaki, Hirokazu Komatsu, Tatsuji Komatsu, Masataka Taguri, Katsuaki Tanaka, Makoto Chuma, Kazushi Numata, Shin Maeda
Kazuo Tarao, Department of Gastroenterology, Tarao’s Gastroenterological Clinic, Yokohama 241-0821, Japan
Akito Nozaki, Makoto Chuma, Kazushi Numata, Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
Hirokazu Komatsu, Department of Gastroenterology, Yokohama Municipal Citizen’s Hospital, Yokohama 221-0855, Japan
Tatsuji Komatsu, Department of Clinical Research, National Hospital Organization Yokohama Medical Center, Yokohama 245-8575, Japan
Masataka Taguri, Department of Data Science, Yokohama City University School of Data Science, Yokohama 236-0004, Japan
Katsuaki Tanaka, Department of Gastroenterology, Hadano Red Cross Hospital, Kanagawa 221-0045, Japan
Shin Maeda, Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Author contributions: Tarao K summarized the data and wrote the paper; Nozaki A, Komatsu H, Komatsu T, Tanaka K, Chuma M, Numata K and Maeda S were responsible for patient follow-up; Taguri M conducted the statistical analyses.
Supported by the Kanagawa Association of Medical and Dental Practitioners.
Institutional review board statement: The study was reviewed and approved by the Yokohama Municipal Citizen’s Hospital Institutional Review Board (Approval No. 19-02-03).
Informed consent statement: This study is a retrospective observational study and does not require consent form.
Conflict-of-interest statement: Tanaka K has received research funding from Bristol-Myers Squibb and Abb Vie; Nozaki A has received research funding from Gilead Sciences; Tarao K, Komatsu H, Komatsu T, Taguri M, Chuma M, Numata K and Maeda S, declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Kazuo Tarao, MD, PhD, Director, Department of Gastroenterology, Tarao’s Gastroenterological Clinic, 2-58-6, Taiyo Building Futamatagawa, Asahi-ku, Yokohama 241-0821, Japan.
duoluoweih7@gmail.com
Received: June 23, 2020
Peer-review started: June 23, 2020
First decision: July 30, 2020
Revised: August 10, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: November 27, 2020
Processing time: 154 Days and 7.3 Hours
BACKGROUND
In hepatocellular carcinoma (HCC), detection and treatment prior to growth beyond 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.
AIM
To examine the impact of the tumor marker alpha-fetoprotein (AFP) or PIVKA-II in detecting very small HCC nodules (≤ 2 cm in maximum diameter, Barcelona stage 0) in the large number of very small HCC. The difference in the behavior of these tumor markers in HCC development was also examined.
METHODS
A total of 933 patients with single-nodule HCC were examined. They were subdivided into 394 patients with HCC nodules ≤ 2 cm in maximum diameter and 539 patients whose nodules were > 2 cm. The rates of patients whose AFP and PIVKA-II showed normal values were examined.
RESULTS
The positive ratio of the marker PIVKA-II was significantly different (P < 0.0001) between patients with nodules ≤ 2 cm in diameter and those with nodules > 2 cm, but there was no significant difference in AFP (P = 0.4254). In the patients whose tumor was ≤ 2 cm, 50.5% showed normal levels in AFP and 68.8% showed normal levels in PIVKA-II. In 36.4% of those patients, both AFP and PIVKA-II showed normal levels. The PIVKA-II-positive ratio was markedly increased with an increase in the tumor size. In contrast, the positivity in AFP was increased gradually and slowly.
CONCLUSION
In the surveillance of very small HCC nodules (≤ 2 cm in diameter, Barcelona clinical stage 0) the tumor markers AFP and PIVKA-II are not so useful.
Core Tip: In hepatocellular carcinoma, detection and treatment prior to nodule growth of 2 cm (Barcelona stage 0) are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites. We surveyed the real impact of the tumor markers alpha-fetoprotein (AFP) or PIVKA-II in detecting very small hepatocellular carcinoma with a large number of cases (≤ 2 cm in diameter 394 cases) and found in AFP that 50.5% and in PIVKA-II that 68.8% showed normal levels. Moreover, 36.4% of the patients showed normal levels in both AFP and PIVKA-II. In the surveillance of very small hepatocellular carcinoma nodules, the tumor markers are not so useful.
