Clinical utility of protein induced by vitamin K absence in patients with chronic hepatitis B virus infection

Abstract

Hepatitis B virus (HBV) is a leading cause of hepatocellular carcinoma (HCC). α-fetoprotein (AFP) is a common tumor marker for the diagnosis of HCC, although not for protein induced by the absence of vitamin K or antagonist-II (PIVKA-II). The present study aimed to evaluate the role of PIVKA-II in the diagnosis of HCC in HBV-infected Vietnamese patients. A total of 166 consecutive HBV-infected Vietnamese patients were enrolled, including 41 HCC, 43 liver cirrhosis (LC), 26 chronic hepatitis (CH) and 56 asymptomatic carriers (ASC). AFP was examined using ELISA, while PIVKA-II was analyzed using Eitest PIVKA-II. The cut-off level of AFP and PIVKA-II was 20 ng/ml and 40 mAU/ml, respectively. Although the markers, AFP (344±356 ng/ml) and PIVKA-II (16,200±25,386 mAU/ml), were the highest in the HCC groups, only PIVKA-II in HCC was significantly higher compared to the other groups (P<0.001). The univariate analysis demonstrated that age over 50, male, genotype C, AFP and PIVKA-II were risk factors of LC and HCC. Results of the receiver operating characteristics (ROC) analysis showed that PIVKA-II was more sensitive to HCC compared to AFP. Moreover, PIVKA-II was strongly correlated with the portal venous thrombosis in HCC, as opposed to AFP. Results of the multivariate analysis demonstrated that PIVKA-II was the strongest independent risk factor of LC and HCC. In conclusion, PIVKA-II is likely to be a better marker for the diagnosis of HCC in chronic HBV-infected Vietnamese patients.

Keywords: Vietnam; hepatitis B virus; hepatocellular carcinoma; protein induced by vitamin K absence or antagonist-II.

Figure 1.

Sensitivity and specificity in the detection of hepatocellular carcinoma (HCC) when the combined cut-off levels used are over 40 mAU/ml prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) and over 20 ng/ml of α-fetoprotein (AFP).

Figure 2.

ROC analysis curves for comparing protein induced by vitamin K absence or antagonist-II (PIVKA-II) and α-fetoprotein (AFP) in detection of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) infected Vietnamese. Cut-off level for PIVKA-II of 40 mAU/ml and for AFP of 20 ng/ml is shown.