Levels of PIVKA-II and alpha-fetoprotein in unresectable hepatocellular carcinoma compared to healthy controls and predictive values of both markers with radiological responses after loco-regional interventions

PeerJ. 2023 Sep 25:11:e15988. doi: 10.7717/peerj.15988. eCollection 2023.

Abstract

Background: The significance of the current study was to determine normative levels of PIVKA-II and AFP in patients with unresectable HCC and healthy participants. The second goal was to assess the roles of PIVKA-II and AFP in predicting radiological response after loco-regional therapy.

Methods: This prospective cohort study enrolled consecutive samples of HCC patients and healthy controls. Venous blood samples were obtained at baseline and after interventions to determine serum levels of PIVKA-II and AFP using the chemiluminescent microparticle immunoassay method. Radiologic responses were determined based on the WHO criteria.

Results: Fifty-four HCC patients (mean age 58.9 years, 49 males) and 40 healthy controls (mean age 33.5 years, 26 males) were recruited. The median serum levels of PIVKA-II and AFP in HCC vs. healthy controls were 988.4 vs. 24.2 mAU/ml and 13.6 vs. 1.7 ng/ml, respectively (both p < 0.001). With ROC curve analysis, the area under the curve (AUC) for PIVKA-II was 0.95 95% CI [0.90-0.99], and for AFP it was 0.98, 95% CI [0.95-1.0]). The cut-off value for PIVKA-II was 41.4 mAU/ml, and AFP was 4.8 ng/ml. PIVKA-II levels correlated significantly with radiological responses (r = 0.64, p = 0.02) but not AFP (r = 0.09, p = 0.2).

Conclusion: PIVKA-II and AFP levels are distinctive between unresectable HCC and healthy controls. However, PIVKA-II, not AFP, can predict the radiological response after loco-regional therapy.

Keywords: Alpha-fetoprotein; Hepatocellular carcinoma; Loco-regional therapy; Protein Induced by Vitamin-K Absence-II; Radiological response.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carcinoma, Hepatocellular* / diagnostic imaging
  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • alpha-Fetoproteins / analysis

Substances

  • acarboxyprothrombin
  • alpha-Fetoproteins

Grants and funding

This research was funded by Universiti Sains Malaysia Short-Term Research Grant (304.PPSG.6315413). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.