Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Real impact of tumor marker AFP and PIVKA-II in detecting very small hepatocellular carcinoma (≤ 2 cm, Barcelona stage 0) - assessment with large number of cases
Kazuo Tarao, Akito Nozaki, Hirokazu Komatsu, Tatsuji Komatsu, Masataka Taguri, Katsuaki Tanaka, Makoto Chuma, Kazushi Numata, Shin Maeda
Kazuo Tarao, Department of Gastroenterology, Tarao’s Gastroenterological Clinic, Yokohama 241-0821, Japan
Akito Nozaki, Makoto Chuma, Kazushi Numata, Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
Hirokazu Komatsu, Department of Gastroenterology, Yokohama Municipal Citizen’s Hospital, Yokohama 221-0855, Japan
Tatsuji Komatsu, Department of Clinical Research, National Hospital Organization Yokohama Medical Center, Yokohama 245-8575, Japan
Masataka Taguri, Department of Data Science, Yokohama City University School of Data Science, Yokohama 236-0004, Japan
Katsuaki Tanaka, Department of Gastroenterology, Hadano Red Cross Hospital, Kanagawa 221-0045, Japan
Shin Maeda, Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Author contributions: Tarao K summarized the data and wrote the paper; Nozaki A, Komatsu H, Komatsu T, Tanaka K, Chuma M, Numata K and Maeda S were responsible for patient follow-up; Taguri M conducted the statistical analyses.
Supported by the Kanagawa Association of Medical and Dental Practitioners.
Institutional review board statement: The study was reviewed and approved by the Yokohama Municipal Citizen’s Hospital Institutional Review Board (Approval No. 19-02-03).
Informed consent statement: This study is a retrospective observational study and does not require consent form.
Conflict-of-interest statement: Tanaka K has received research funding from Bristol-Myers Squibb and Abb Vie; Nozaki A has received research funding from Gilead Sciences; Tarao K, Komatsu H, Komatsu T, Taguri M, Chuma M, Numata K and Maeda S, declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kazuo Tarao, MD, PhD, Director, Department of Gastroenterology, Tarao’s Gastroenterological Clinic, 2-58-6, Taiyo Building Futamatagawa, Asahi-ku, Yokohama 241-0821, Japan. duoluoweih7@gmail.com
Received: June 23, 2020
Peer-review started: June 23, 2020
First decision: July 30, 2020
Revised: August 10, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: November 27, 2020
ARTICLE HIGHLIGHTS
Research background
In hepatocellular carcinoma (HCC), detection and treatment prior to growth of 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites. However, we often experience cases whose tumor size was ≤ 2 cm and who showed normal values in both AFP and PIVKA-II.
Research motivation
Previous reports concerning the tumor markers AFP or PIVKA-II in very small HCC included relatively small number of cases, and a larger study is necessary in order to elucidate the precise levels of these markers.
Research objectives
In the present study, we surveyed the levels of AFP and PIVKA-II in a large number of very small HCC cases (≤ 2 cm in diameter, 394 cases).
Research methods
We analyzed 933 patients with single HCC nodules and surveyed the limitation of these tumor markers in the surveillance of very small HCC (≤ 2 cm, Barcelona stage 0, 394 cases).
Research results
It was found in patients with very small HCC (≤ 2 cm in diameter) that AFP and PIVKA-II levels were normal in 50.5% and 68.8%, respectively. Moreover, 36.4% of the patients showed normal levels of both AFP and PIVKA-II. We examined the difference in behavior of these tumor markers in relation to the size of HCC nodules and found that PIVKA-II positive ratio was markedly increased with an increase in tumor size, whereas the positivity in AFP was increased gradually and slowly.
Research conclusions
More than one third of the patients with very small HCC nodule (≤ 2 cm in diameter, Barcelona stage 0) were dropped from the surveillance using the tumor markers AFP and PIVKA-II.
Research perspectives
We propose that for detecting very small HCC nodules, we must survey patients with liver diseases by imaging modalities, especially by magnetic resonance imaging.
