Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion.

Abstract

BACKGROUND & AIMS:

Prothrombin induced by vitamin K absence-II (PIVKA-II) is a diagnostic and surveillance marker for HCC mainly used in Asia, and has also been shown to be a predictor of microvascular invasion (MVI), a major prognostic factor in HCC. However, experience with PIVKA-II in Europe remains limited.

METHODS:

In a French cohort, we conducted a case-control study to compare the performances of α-fetoprotein (AFP) and PIVKA-II serum levels for diagnosis of early stage HCC, and we determined the value of PIVKA-II serum and tissue expression in pre-operative detection of MVI. 43 cirrhotic control patients and 85 HCC cases were included, of which 54 (63.5%) had early stage HCC (n=22 very early, n=32 early). PIVKA-II tissue expression was assessed by immunohistochemistry in HCC surgical samples.

RESULTS:

For the diagnosis of early HCC, PIVKA-II had a sensitivity of 77% and a specificity of 82% at a cut-off of 42 mAU/ml, vs. 61% and 50% for AFP at a cut-off of 5.5 ng/ml (AUC 0.81 vs. 0.58, respectively). A PIVKA-II level >90 mAU/ml was an independent predictor of MVI (HR 3.5; 95% CI 1.08-11.8; p=0.043). High PIVKA-II tissue expression was significantly associated with the presence of MVI (p=0.001). When combining PIVKA-II immunostaining with the PIVKA-II serum level, sensitivity and specificity for the diagnosis of MVI increased from 70% to 87% and 63% to 90%, respectively.

CONCLUSIONS:

PIVKA-II was more efficient than AFP for the diagnosis of early HCC, and could be used as a predictive biomarker of MVI.

• Authors: Nicolas Poté, François Cauchy, Miguel Albuquerque, Hélène Voitot, Jacques Belghiti, Laurent Castera, Hervé Puy, Pierre Bedossa, Valérie Paradis
• Journal: Journal of hepatology (J Hepatol) Vol. 62 Issue 4 Pg. 848-54 (Apr 2015) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 25450201 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• Biomarkers, Tumor
• Protein Precursors
• alpha-Fetoproteins
• acarboxyprothrombin
• Prothrombin

Topics

• Adult
• Aged
• Biomarkers (blood, metabolism)
• Biomarkers, Tumor (blood, metabolism)
• Carcinoma, Hepatocellular (blood, pathology)
• Case-Control Studies
• Comparative Effectiveness Research
• Early Detection of Cancer
• Female
• France
• Humans
• Immunohistochemistry
• Liver Neoplasms (blood, pathology)
• Male
• Middle Aged
• Neoplasm Invasiveness (diagnosis)
• Predictive Value of Tests
• Prognosis
• Protein Precursors (blood, metabolism)
• Prothrombin (metabolism)
• ROC Curve
• Sensitivity and Specificity
• alpha-Fetoproteins (metabolism)