Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 6;16(1):317.
doi: 10.1186/s13104-023-06600-y.

The diagnostic performance of AFP and PIVKA-II models for non-B non-C hepatocellular carcinoma

Vinh Thanh Tran #  1 , Thang Thanh Phan #  2 , Tran Bao Nguyen  1 , Thao Thi Le  1 , Thanh-Tram Thi Tran  3 , Anh-Thu Thi Nguyen  3 , Hang Thuy Nguyen  3 , Ngoc-Diep Bui Nguyen  3 , Toan Trong Ho  1 , Suong Phuoc Pho  1 , Thuy-An Thi Nguyen  1 , Hue Thi Nguyen  1 , Huyen Thi Mai  1 , Bich-Tuyen Thi Pham  1 , Khoa Dinh Nguyen  4 , Binh Thanh Le  5 , Thuc Tri Nguyen  5 , Son Truong Nguyen  5
Affiliations

The diagnostic performance of AFP and PIVKA-II models for non-B non-C hepatocellular carcinoma

Vinh Thanh Tran et al. BMC Res Notes. .

Abstract

Objective: This study aims to describe the diagnostic performance of alpha-fetoprotein (AFP), alpha-fetoprotein L3 isoform (AFP-L3), protein induced by vitamin K absence II (PIVKA-II), and combined biomarkers for non-B non-C hepatocellular carcinoma (NBNC-HCC).

Results: A total of 681 newly-diagnosed primary liver disease subjects (385 non-HCC, 296 HCC) who tested negativity for the hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) enrolled in this study. At the cut-off point of 3.8 ng/mL, AFP helps to discriminate HCC from non-HCC with an area under the curve (AUC) value of 0.817 (95% confidence interval [CI]: 0.785-0.849). These values of AFP-L3 (cut-off 0.9%) and PIVKA-II (cut-off 57.7 mAU/mL) were 0.758 (95%CI: 0.725-0.791) and 0.866 (95%CI: 0.836-0.896), respectively. The Bayesian Model Averaging (BMA) statistic identified the optimal model, including patients' age, aspartate aminotransferase, AFP, and PIVKA-II combination, which helps to classify HCC with better performance (AUC = 0.896, 95%CI: 0.872-0.920, P < 0.001). The sensitivity and specificity of the optimal model reached 81.1% (95%CI: 76.1-85.4) and 83.2% (95%CI: 78.9-86.9), respectively. Further analyses indicated that AFP and PIVKA-II markers and combined models have good-to-excellent performance detecting curative resected HCC, separating HCC from chronic hepatitis, dysplastic, and hyperplasia nodules.

Keywords: AFP; AFP-L3; Diagnosis; NBNC-HCC; PIVKA-II.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Distribution of age, fibrinogen, glycemia, BUN, creatinine, ALT, AST, bilirubin, AFP, AFP-L3, and PIVKA-II expression between non-HCC and HCC patients (A-K)
Fig. 3
Fig. 3
Selection of diagnostic tests by the BMA statistic (A), the performance of optimal model versus individual markers (B), and calibration analysis (C)
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. doi: 10.3322/caac.21660. - DOI - PubMed
    1. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142(6):1264–1273e1. doi: 10.1053/j.gastro.2011.12.061. - DOI - PMC - PubMed
    1. Vogel A, Cervantes A, Chau I, Daniele B, Llovet JM, Meyer T, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv238–55. doi: 10.1093/annonc/mdy308. - DOI - PubMed
    1. Zhang J, Chen G, Zhang P, Zhang J, Li X, Gan D, et al. The threshold of alpha-fetoprotein (AFP) for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. PLoS ONE. 2020;15(2):e0228857. doi: 10.1371/journal.pone.0228857. - DOI - PMC - PubMed
    1. Fan J, Chen Y, Zhang D, Yao J, Zhao Z, Jiang Y, et al. Evaluation of the diagnostic accuracy of des-gamma-carboxy prothrombin and alpha-fetoprotein alone or in combination for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Oncol. 2020;34:245–55. doi: 10.1016/j.suronc.2020.05.002. - DOI - PubMed