Protein induced by vitamin K absence or antagonist II application research in hepatocellular carcinoma

Objective To investigate the diagnostic value and biological features of protein induced by vitamin K absence or antagonist Ⅱ (PIVKA-Ⅱ) and alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC). Methods Serum samples of 72 patients with HCC (HCC group), 54 patients with hepatitis B cirrhosis (cirrhosis group) and 30 patients with chronic hepatitis B (CHB) without cirrhosis (CHB group) were tested with the PIVKA-Ⅱ and AFP detection kits. Diagnostic efficacies of PIVKA-Ⅱ and AFP were evaluated by receiver-operating characteristic curve (ROC). The cut-off value of PIVKA-Ⅱ for diagnose HCC was also determined. Sensitivities and specificities of PIVKA-Ⅱ and AFP were compared. Results The medians of PIVKA-Ⅱ levels in HCC group, cirrhosis group and CHB group were 14.36, 11.21, and 329.88 mAU/mL, respectively. The serum PIVKA-Ⅱ level in the HCC group was significantly higher than that in cirrhosis group (U=342.50, P 0.05). The serum PIVKA-Ⅱ levels in patients with BCLC stage A, B, C in HCC group were 22.13, 345.46, and 13 057.72 mAU/mL, respectively. After comparison of stage A and C with stage B, the differences were both statistically significant (stage A to B: U=119.0, P<0.01; stage B to C: U=158.0, P<0.01). The sensitivity and specificity of PIVKA-Ⅱ with a cut-off value of 30.01 mAU/mL by means of Youden index were 0.750 and 1.000, respectively. When combined PIVKA-Ⅱ with AFP, the sensitivity and specificity were 0.800 and 0.964, respectively. The area under the curve (AUC) was highest (AUC=0.930, 95%CI: 0.852—0.974), and significantly higher than that using PIVKA-Ⅱ alone (AUC=0.892, 95%CI: 0.834—0.950, χ2=21.43, P<0.01). Conclusions The diagnostic value of serum PIVKA-Ⅱ is superior to AFP. Combined with AFP, serum PIVKA-Ⅱ can improve the detection rate of HCC, and has advantages during the development of HCC and can be used to monitor the condition of HCC patients. Key words: PIVKA-Ⅱ; Carcinoma, hepatocellular; Diagnosis