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. 2022 Nov;103(5):271-279.
doi: 10.4174/astr.2022.103.5.271. Epub 2022 Nov 1.

Prognostic value of preoperative protein-induced vitamin K absence or antagonist II after liver resection for hepatitis B-related hepatocellular carcinoma: a nationwide multicenter study

Dahn Byun  1 , Seul Gi Lee  1 , Hyeyoung Kim  1 , Yunghun You  1 , Jaehag Jung  1 , Je Ho Jang  1 , Moon-Soo Lee  1 , Chang-Nam Kim  1 , Byung Sun Cho  1 , Yoon-Jung Kang  1 ; Korean Liver Cancer Association
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Prognostic value of preoperative protein-induced vitamin K absence or antagonist II after liver resection for hepatitis B-related hepatocellular carcinoma: a nationwide multicenter study

Dahn Byun et al. Ann Surg Treat Res. 2022 Nov.

Abstract

Purpose: Although protein-induced vitamin K absence or antagonist II (PIVKA-II) has been used as a diagnostic tool for hepatocellular carcinoma (HCC), its prognostic value remains unclear.

Methods: This was a nationwide multicenter study using the database of the Korean Liver Cancer Association. Patients with hepatitis B-related HCC who underwent liver resection as the first treatment after initial diagnosis (2008-2014) were selected randomly. Propensity score matching (1:1) was performed for comparative analysis between those with low and high preoperative PIVKA-II. Univariable and multivariable Cox proportional-hazards regression were used to identify prognostic factors for HCC-specific survival.

Results: Among 6,770 patients, 956 patients were included in this study. After propensity score matching, the 2 groups (n = 245, each) were well balanced. The HCC-specific 5-year survival rate was 80.9% in the low PIVKA-II group and 78.7% in the high PIVKA-II group (P = 0.605). In univariable analysis, high PIVKA-II (>106.0 mAU/mL) was not a significant predictor for worse HCC-specific survival (hazard ratio [HR], 1.183; 95% confidence interval [CI], 0.76-1.85; P = 0.461). In multivariable analysis, hyponatremia of <135 mEq/L (HR, 4.855; 95% CI, 1.67-14.12; P = 0.004), preoperative ascites (HR, 4.072; 95% CI, 1.59-10.43; P = 0.003), microvascular invasion (HR, 3.112; 95% CI, 1.69-5.74; P < 0.001), and largest tumor size of ≥5.0 cm (HR, 2.665; 95% CI, 1.65-4.31; P < 0.001), but not preoperative high PIVKA-II, were independent predictors for worse HCC-specific survival.

Conclusion: Preoperative PIVKA-II is not an independent prognostic factor for HCC-specific survival after liver resection for hepatitis B-related HCC.

Keywords: Biomarkers; Hepatectomy; PIVKA-II; Prognosis.

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Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Study population. HCC, hepatocellular carcinoma; PIVKA-II, protein-induced vitamin K absence or antagonist II.
Fig. 2
Fig. 2. Receiver-operating characteristic (ROC) curve analysis. PIVKA-II, protein-induced vitamin K absence or antagonist II.
Fig. 3
Fig. 3. Survivals. (A) Overall survival in matched cohorts. (B) Hepatocellular carcinoma (HCC)-specific survival in matched cohorts. LP, low protein-induced vitamin K absence or antagonist II; HP, high protein-induced vitamin K absence or antagonist II.
See this image and copyright information in PMC

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