Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3928
Peer-review started: August 13, 2014
First decision: September 15, 2014
Revised: October 10, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
AIM: To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) in chronic hepatitis B (CHB).
METHODS: A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma (HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic (AUROC) curves of PIVKA-II, AFP and their combination were calculated and compared.
RESULTS: The optimal cutoff values for PIVKA-II and AFP were 40 mAU/mL and 10 ng/mL, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-II and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-II and AFP were not significantly different (0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-II was significantly better than that of AFP in patients with cirrhosis (0.870 vs 0.812, P = 0.042). When PIVKA-II and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-II alone for the differentiation of HCC from nonmalignant CHB (P < 0.05), especially when cirrhosis was present (P < 0.05).
CONCLUSION: Serum PIVKA-II might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.
Core tip: Hepatocellular carcinoma (HCC) surveillance is crucial for patients with chronic hepatitis B (CHB). There have been few studies that have compared the levels of prothrombin induced by vitamin K absence-II (PIVKA-II) and AFP in hepatitis B virus-associated HCC. Serum PIVKA-II, at a level of 40 mAU/mL, is a useful tumor marker to distinguish patients with HCC from those with nonmalignant CHB, especially liver cirrhosis (LC). A combination of AFP and PIVKA-II could enhance early detection of HCC in patients with CHB. Therefore, serum PIVKA-II levels should be measured in combination with serum AFP levels during the follow-up of patients with CHB and particularly those with LC.