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. 2020 Nov 27;12(11):1046-1054.
doi: 10.4254/wjh.v12.i11.1046.

Real impact of tumor marker AFP and PIVKA-II in detecting very small hepatocellular carcinoma (≤ 2 cm, Barcelona stage 0) - assessment with large number of cases

Kazuo Tarao  1 , Akito Nozaki  2 , Hirokazu Komatsu  3 , Tatsuji Komatsu  4 , Masataka Taguri  5 , Katsuaki Tanaka  6 , Makoto Chuma  2 , Kazushi Numata  2 , Shin Maeda  7
Affiliations

Real impact of tumor marker AFP and PIVKA-II in detecting very small hepatocellular carcinoma (≤ 2 cm, Barcelona stage 0) - assessment with large number of cases

Kazuo Tarao et al. World J Hepatol. .

Abstract

Background: In hepatocellular carcinoma (HCC), detection and treatment prior to growth beyond 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.

Aim: To examine the impact of the tumor marker alpha-fetoprotein (AFP) or PIVKA-II in detecting very small HCC nodules (≤ 2 cm in maximum diameter, Barcelona stage 0) in the large number of very small HCC. The difference in the behavior of these tumor markers in HCC development was also examined.

Methods: A total of 933 patients with single-nodule HCC were examined. They were subdivided into 394 patients with HCC nodules ≤ 2 cm in maximum diameter and 539 patients whose nodules were > 2 cm. The rates of patients whose AFP and PIVKA-II showed normal values were examined.

Results: The positive ratio of the marker PIVKA-II was significantly different (P < 0.0001) between patients with nodules ≤ 2 cm in diameter and those with nodules > 2 cm, but there was no significant difference in AFP (P = 0.4254). In the patients whose tumor was ≤ 2 cm, 50.5% showed normal levels in AFP and 68.8% showed normal levels in PIVKA-II. In 36.4% of those patients, both AFP and PIVKA-II showed normal levels. The PIVKA-II-positive ratio was markedly increased with an increase in the tumor size. In contrast, the positivity in AFP was increased gradually and slowly.

Conclusion: In the surveillance of very small HCC nodules (≤ 2 cm in diameter, Barcelona clinical stage 0) the tumor markers AFP and PIVKA-II are not so useful.

Keywords: AFP; Barcelona clinical stage; Hepatocellular carcinoma; PIVKA-II; Tumor markers.

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Conflict of interest statement

Conflict-of-interest statement: Tanaka K has received research funding from Bristol-Myers Squibb and Abb Vie; Nozaki A has received research funding from Gilead Sciences; Tarao K, Komatsu H, Komatsu T, Taguri M, Chuma M, Numata K and Maeda S, declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Relationship between tumor size and PIVKA-II and alpha-fetoprotein positivity. AFP: Alpha-fetoprotein.
Figure 2
Figure 2
Correlation between tumor size and PIVKA-II levels.
Figure 3
Figure 3
Correlation between tumor size and alpha-fetoprotein levels. AFP: Alpha-fetoprotein.
See this image and copyright information in PMC

References

    1. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–1255. - PubMed
    1. Stravitz RT, Heuman DM, Chand N, Sterling RK, Shiffman ML, Luketic VA, Sanyal AJ, Habib A, Mihas AA, Giles HC, Maluf DG, Cotterell AH, Posner MP, Fisher RA. Surveillance for hepatocellular carcinoma in patients with cirrhosis improves outcome. Am J Med. 2008;121:119–126. - PubMed
    1. Han K, Kim JH. Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system. World J Gastroenterol. 2015;21:10327–10335. - PMC - PubMed
    1. Kawano Y, Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Shibata K, Ohta M, Kitano S. Short- and long-term outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol. 2008;15:1670–1676. - PubMed
    1. Hayashi M, Matsui O, Ueda K, Kawamori Y, Kadoya M, Yoshikawa J, Gabata T, Takashima T, Nonomura A, Nakanuma Y. Correlation between the blood supply and grade of malignancy of hepatocellular nodules associated with liver cirrhosis: evaluation by CT during intraarterial injection of contrast medium. AJR Am J Roentgenol. 1999;172:969–976. - PubMed