The prothrombin induced by vitamin K absence or antagonist-II as a good diagnostic factor in the HBV related BCLC 0-A stage hepatocellular carcinoma

Objective To assess the diagnostic value of the prothrombin induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) in Chinese patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC). Methods The study group consisted of 82 HCC patients [group A, Barcelona Clinic Liver Cancer (BCLC) 0-A stage], 169 patients with chronic hepatitis B or HBV-related liver cirrhosis (group B), 68 HBV or hepatitis B surface antigen (HBsAg) carrier patients (group C) and 138 healthy controls (group D). All patients and controls were examined for serum levels of PIVKA-Ⅱand alpha-fetoprotein (AFP). Results The median serum levels of PIVKA-Ⅱ in groups A, B, C and D were 209.5 mAU/ml, 16 mAU/ml, 17 mAU/ml and 15 mAU/ml, respectively. PIVKA-Ⅱ had better area under the receiver operating characteristic curve [0.857 (95% CI: 0.804~0.913)] than AFP[0.729 (95% CI: 0.654~0.801)](P<0.01). The optimal PIVKA-Ⅱ cutoff value was 26.5 mAU/ml. A combination detection of serum levels of PIVKA-Ⅱ and AFP could increase the sensitivity, especially, negative predictive value (NPV) and positive predictive value (PPV) in diagnosis of HCC. Conclusions PIVKA-Ⅱ is better than AFP in diagnosis of HBV related BCLC 0-A stage HCC and PIVKA-Ⅱ can serve as a marker for screening of HBV related HCC. Key words: Prothrombin/ME; alpha-fetoproteins/ME; Liver neoplasms/ME; Hepatitis B virus