PIVKA-II is a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients.
PIVKA-II is a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients.
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DOI：
10.1097/md.0000000000007266
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发表时间：
2017-06
期刊：
影响因子：
1.6
通讯作者：
Pollicino T
中科院分区：
文献类型：
--
作者：
Saitta C;Raffa G;Alibrandi A;Brancatelli S;Lombardo D;Tripodi G;Raimondo G;Pollicino T
维生素K缺乏-II诱导的蛋白(PIVKA-II)是一种潜在的肝细胞癌筛查标志物。在对肝硬变患者进行超声(US)评估时，关于其在区分肿瘤和再生结节中的作用的数据有限。本研究的目的是探讨PIVKA-II在超声诊断不明的肝结节病例中的诊断价值。纳入90例有肝脏结节超声证据的肝硬变患者(S)。所有患者均在超声检查后1周内采血，随后进行随访。40/90例确诊为肝细胞癌，所有病例均处于非常早期/早期阶段。所有患者在随访结束时检测PIVKA-II和甲胎蛋白(AFP)。在单变量和多变量分析中，PIVKA-II在截止值为60 MAU/m L时与肝癌显著相关(分别为P = .016和P = .032)。单因素分析显示，甲胎蛋白水平在6.5ngmL时与肝细胞癌无关(P = .246)。ROC曲线显示，PIVKA-II的敏感性为60%，特异性为88%，阳性预测值(PPV)为80%，阴性预测值(NPV)为73%；AFP的敏感性为67%，特异性为68%，PPV为63%，NPV为72%。AUROC曲线显示，两种生物标志物的结合提高了对肝癌诊断的准确性(AUC 0.76；敏感性70%，特异性94%，PPV 91%，NPV 79%)。总之，PIVKA-II是诊断肝硬变患者超声检出肝结节的有用工具，与AFP联合应用可提供较高的肝细胞癌诊断准确率。
Protein induced by vitamin K absence-II (PIVKA-II) is a potential screening marker for hepatocellular carcinoma (HCC). Limited data are available about its utility in discriminating neoplastic from regenerative nodules at ultrasonography (US) evaluation in cirrhotic patients. Aim of this study was to investigate the diagnostic utility of PIVKA-II in cases showing liver nodules of uncertain diagnosis at US. Ninety cirrhotics with US evidence of liver nodule(s) were enrolled. All patients underwent blood sampling within 1 week of US and were thereafter followed up. HCC was confirmed in 40/90 cases, and in all cases it was in a very early/early stage. All sera were tested for PIVKA-II and alpha-fetoprotein (AFP) at the end of follow-up. PIVKA-II at a cut off of 60 mAU/mL was significantly associated with HCC at both univariate and multivariate analysis (P = .016 and P = .032, respectively). AFP at a cut off of 6.5 ng/mL was not associated with HCC at univariate analysis (P = .246). ROC curves showed that PIVKA-II had 60% sensitivity, 88% specificity, 80% positive predictive value (PPV), and 73% negative predictive value (NPV), whereas AFP had 67% sensitivity, 68% specificity, 63% PPV, and 72% NPV. AUROC curves showed that the combination of both biomarkers increased the diagnostic accuracy for HCC (AUC 0.76; sensitivity 70%, specificity 94%, PPV 91%, and NPV 79%). In conclusion, PIVKA-II is a useful tool for the diagnostic definition of US-detected liver nodules in cirrhotic patients, and it provides high diagnostic accuracy for HCC when combined with AFP.