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

Table 1 Background of the hepatocellular carcinoma patients

	Maximum diameter of nodules
		≤ 20 mm	> 20 mm
Number of patients		394	539
Sex	Male	230 (58.4%)	392 (72.7%)
	Female	164 (41.6%)	147 (22.3%)
Age in yr		71.3 ± 8.8	72.5 ± 10.1
Etiology	HBV	33 (8.4%)	39 (7.2%)
	HCV	274 (69.5%)	266 (49.4%)
	PBC	4 (1.0%)	6 (1.1%)
	Alcohol	17 (4.3%)	53 (9.8%)
	NASH	4 (1.0%)	8 (1.5%)
	Autoimmune hepatitis	3 (0.8%)	2 (0.4%)
	Unknown	23 (5.8%)	62 (11.5%)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; NASH: Non-alcoholic steatohepatitis; PBC: Primary biliary cirrhosis.

Table 2 Positive rates of alpha-fetoprotein and PIVKA-II in patients whose tumor size was ≤ 2 cm and those whose tumor size was more than 2 cm

		Maximum diameter of HCC nodules		P value1
		≤ 2 cm, n = 394	> 2 cm, n = 539
AFP	(+)	195 (49.5%)	281 (52.1%)	0.4254
	(-)	199 (50.5%)	258 (47.9%)
PIVKA	(+)	123 (31.2%)	385 (71.4%)	< 0.0001
	(-)	271 (68.8%)	154 (28.6%)

¹χ² tests. AFP: Alpha-fetoprotein; HCC: Hepatocellular carcinoma.

Table 3 The rates of patients whose alpha-fetoprotein and PIVKA-II showed normal values in those whose maximum tumor size was ≤ 2 cm, n = 394 cases

HCC tumor marker	No. of cases (%)
AFP, normal cases	199 (50.5)
PIVKA-II, normal cases	271 (68.8)
Both AFP and PIVKA-II, normal cases	142 (36.4)

AFP: Alpha-fetoprotein; HCC: Hepatocellular carcinoma.

Table 4 Treatment methods of hepatocellular carcinoma patients

Therapy	No of treated patients
	Group
	≤ 2 cm, n = 394	> 2 cm, n = 539
Hepatectomy	45	110
RFA	223	107
TACE	56	136
TACE + RFA	6	32
TAI	2	10
Chemotherapy	9	21
BSC	10	60
Others	13	63

BSC: Best supportive care; RFA: Radiofrequency ablation; TACE: Transcatheter arterial chemoembolization; TAI: Transcatheter arterial infusion.