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. 2017 Jul-Aug;31(4):695-700.
doi: 10.21873/invivo.11115.

Diagnostic Accuracy of PIVKA-II, Alpha-Fetoprotein and a Combination of both in Diagnosis of Hepatocellular Carcinoma in Patients Affected by Chronic HCV Infection

Ivan Gentile  1 , Antonio Riccardo Buonomo  2 , Riccardo Scotto  1 , Emanuela Zappulo  1 , Canio Carriero  1 , Mauro Piccirillo  3 , Francesco Izzo  3 , Marianna Rizzo  4 , Dionigio Cerasuolo  4 , Guglielmo Borgia  1 , Ernesta Cavalcanti  4
Affiliations

Diagnostic Accuracy of PIVKA-II, Alpha-Fetoprotein and a Combination of both in Diagnosis of Hepatocellular Carcinoma in Patients Affected by Chronic HCV Infection

Ivan Gentile et al. In Vivo. 2017 Jul-Aug.

Abstract

Background/aim: Patients affected by liver cirrhosis are at high risk for developing hepatocellular carcinoma (HCC). The aim of this study was to evaluate the feasibility of PIVKA-II (protein induced by vitamin K absence or antagonist-II) alone or in combination with α-1 fetoprotein (AFP), as a screening marker for development of HCC.

Materials and methods: A case-control study was conducted in 2 hospital wards in Naples. All anti-HCV-positive patients affected by HCC were considered as cases, while consecutive anti-HCV-positive patients without HCC were considered as controls.

Results: Overall, 160 patients were enrolled, 56 cases and 104 controls. At the set cut-off of 36 mAU/ml, PIVKA-II was more sensitive (78.6% vs. 60%), but less specific than AFP at the set cut-off of 12 ng/ml (66.3% vs. 77.2%). The negative predictive value of PIVKA in combination with AFP was 93.2%.

Conclusion: PIVKA II, when combined with AFP, may be considered as a screening test for HCC due to its high negative predictive value.

Keywords: AFP; Cirrhosis; HCC; HCV; PIVKA-II.

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Figures

Figure 1
Figure 1. Linear correlation between AFP and PIVKA-II. PIVKA: prothrombin induce\d by vitamin K absence-II; AFP: α-fetoprotein; HCC: hepatocellular carcinoma
Figure 2
Figure 2. Receiver operating characteristics (ROC) curve comparing specificity and sensibility of PIVKA-II and AFP in detecting hepatocellular carcinoma in patients affected by HCV chronic liver disease. PIVKA: prothrombin induced by vitamin K absence-II; AFP: α-Fetoprotein; HCC: hepatocellular carcinoma
Figure 3
Figure 3. Box plot showing PIVKA-II levels according to CLIP stage. Patients were divided in two groups: the one who have a CLIP stage of 0-2 and the others who have a CLIP stage of 3-4. PIVKA-II: prothrombin induced by vitamin K absence-II: CLIP score (The Cancer of the Liver Italian Program score).
Figure 4
Figure 4. Box plot showing AFP levels according to CLIP stage. Patients were divided in two groups: the one who have a CLIP stage of 0-2 and the others who have a CLIP stage of 3-4. AAFP: α–fetoprotein; CLIP score (The Cancer of the Liver Italian Program score).
See this image and copyright information in PMC

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