Prothrombin induced by vitamin K Absence-II versus alpha-fetoprotein in detection of both resectable hepatocellular carcinoma and early recurrence after curative liver resection: A retrospective cohort study. (September 2022)

• Record Type: Journal Article
• Authors: Wang, Ming-Da; Sun, Li-Yang; Qian, Guo-Jun; Li, Chao; Gu, Li-Hui; Yao, Lan-Qing; Diao, Yong-Kang; Pawlik, Timothy M.; Lau, Wan Yee; Huang, Dong-Sheng; Shen, Feng; Yang, Tian
• Is Part Of: International journal of surgery. Volume 105(2022)
• Publication Date: 2022-09
• Subjects: Hepatocellular carcinoma -- Prothrombin induced by vitamin K absence-II -- Alpha-fetoprotein -- Resection -- Early recurrence -- Diagnosis; HCC Hepatocellular carcinoma -- AFP alpha-fetoprotein -- PIVKA-II prothrombin induced by vitamin K absence-II -- HBV Hepatitis B virus -- CT Computed tomography -- PET Positron emission tomography -- MRI Magnetic resonance imaging -- BCLC Barcelona Clinic Liver Cancer -- OS Overall survival -- SD Standard deviation -- HR Hazard ratio -- MV multivariable -- UV univariable -- CI Confidence interval; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2022.106843
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) are two commonly used biomarkers for detection and prognostic prediction of hepatocellular carcinoma (HCC). This study sought to evaluate and compare the use of these two biomarkers to detect HCC, as well as predict postoperative early recurrence (within 2 years after HCC resection). Methods: Data on consecutive patients who underwent curative resection for HCC between 2014 and 2020 was prospectively collected and reviewed. Serum AFP and PIVKA-II levels within one week before surgery or at the time of detection of early recurrence were assessed; preoperative AFP positivity (≥20 ng/ml) and preoperative PIVKA-II positivity (≥40 mAU/ml) were examined relative to recurrence using univariate and multivariate Cox-regression analyses. Results: Among 751 patients who underwent curative HCC resection, 589 (78.4%) patients had preoperative PIVKA-II positivity versus 498 (66.3%) patients had preoperative AFP positivity ( P < 0.001). With a median follow-up of 41.6 months, 370 (50.1%) patients had an early HCC recurrence; among patients with an early recurrence, the proportion of patients with PIVKA-II positivity versus AFP positivity (76.5% vs. 60.0%, P = 0.002) was higher. On multivariate analysis, preoperative PIVKA-II positivity, but not preoperative AFP positivity was an independent risk factor to predict early recurrence after HCC resection. Conclusions: AFP and PIVKA-II are useful biomarkers to detect resectable HCC and predict early recurrence after HCC resection, with the latter showing higher rates of positivity. Preoperative PIVKA-II positivity was independently associated with early recurrence following HCC resection. Graphical abstract: Image 1 Highlights: Compared with AFP, PIVKA-II is more sensitive in detection of resectable HCC. PIVKA-II is more useful than AFP to detect post-epatectomy recurrent HCC. Preoperative PIVKA-II is independently associated with early recurrence after HCC resection.