Abstract
Correlation of Protein Induced by Vitamin K Absence II (PIVKA-II) and Alpha-Fetoprotein (AFP) Levels to the Clinicopathologic Features of Hepatocellular Carcinoma (HCC)
Matthew Joseph Po, MD; Jenny Limquiaco, MD; Derek Leand Tan, MD; Adrian Alick Bonghanoy, MD; Aaron Lemuel Ong, MD; Jan Catherine Carrera, MD
Chong Hua Hospital
Significance: AFP is the most commonly used serum biomarker for HCC, with elevated levels linked to early recurrence, advanced stages, and poor prognosis. PIVKA-II, a newer biomarker, has shown higher sensitivity in detecting HCC and correlates with tumor size and Barcelona Clinic Liver Cancer (BCLC) Stage. This study aims to investigate the relationship between AFP, PIVKA-II, and clinicopathologic features of HCC to further understand their clinical utility.
Methodology: This cross-sectional study reviewed records from adult HCC patients at a tertiary hospital. Data on AFP, PIVKA-II, demographics, liver function tests, tumor characteristics, presence of portal vein thrombosis (PVT), and metastasis were collected. Statistical comparisons involved the Kruskal-Wallis test, Dunn’s post hoc test, and Receiver Operating Characteristic (ROC) analyses to evaluate the diagnostic performance of AFP and PIVKA-II.
Results: Among the 92 patients in the study, viral hepatitis-related HCC showed significantly higher AFP levels (p=0.010), but not PIVKA-II (p=0.071). Both biomarkers correlated with larger tumor size (p=0.009 for AFP, p=0.002 for PIVKA-II) and greater tumor number (p=0.010 for AFP, p<0.001 for PIVKA-II). Both levels also increased with advancing BCLC stages (p=0.010 for AFP, p=0.002 for PIVKA-II). PIVKA-II outperformed AFP as a predictor of lymph node metastasis (AUC 0.711, p<0.001 vs AUC 0.622, p=0.063), with 72% sensitivity at a threshold of 2,960.50 mAU/mL, and an 86% negative predictive value. Neither biomarker showed strong predictive value for PVT or distant metastasis.
Conclusion: AFP and PIVKA-II are correlated with tumor burden and advanced HCC stages, with PIVKA-II providing moderate predictive value for lymph node metastasis.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |