PIVK-II in Hepatocellular Carcinoma

Abstract

Protein induced by vitamin K absence or antagonist II(PIVKA-II) is a diagnostic marker of hepatocelllar carcinoma(HCC0 that has attracted a significant attraction for its high specificity compared to AFP. (Objectives) This study was conducted to evaluate the relationship of two serum markers(AFP and PIVKA-II) and the clinicopathological characteristics of HCC.(Materials and methods) During the period from Feb. 1992 through Jun. 1993, serum AFP and plasma PIVKA-II levels were measured in 37 patients with HCC, 20 of whom had liver resection. AFP level greater than 20 ng/mL and PIVKA-II level greater than 0.1 AU/mL were considered positive. Aalues above 200 ng/mL and 0.3 AU/mL were respectively deemed strong positive. The results were analyzed statistically using χ2 test.(Results) The mean age of 37 patients was 49.6 years and male-to-female ration was 6.4:1. HBsAg was positive in 35 patients(94.6%). None of the patients tested positive for anti-HCV. Twenty-nine patients(78.4%) had co-existent cirhosis. Sensitivity of AFP and PIVKA-II was 75.7% and 56.8% respectively. When these 2 markers were used complementarily, the sensitivity increased to 83.7%. Of 9 cases with normal level of AFP, 2 patients(22.2%) showed elevation of PIVKA-II. Five(38.5%) of 13 cases with AFP level below 200 ng/mL had abnormal PIVKA-II concentrations. There was no correlation between AFP level and PIVKA-II level(r=0.138). In patients with tumors less than 5 cm in diameter, AFP and PIVKA-II were abnormally elevated in 57.1% and 28.6%, respectively. there was no correlation between the markers and the status of HBsAg and cirrhosis. The markers showed no correlation with pathological features other than cell grade. (Conclusion) The use of these two complementary markers contributed to increased detection of HCC. In the regular follow-up of the patients with chronic liver disease, AFP seems to be more useful than PIVKA-II.