Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion
Performance of PIVKA-II for early hepatocellular carcinoma diagnosis and prediction of microvascular invasion
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DOI：
10.1016/j.jhep.2014.11.005
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发表时间：
2015-04-01
影响因子：
25.7
通讯作者：
Paradis, Valerie
中科院分区：
文献类型：
--
作者：
Pote, Nicolas;Cauchy, Franois;Paradis, Valerie
背景和目标：维生素K缺乏诱导的凝血酶原-II（PIVKA-II）是主要在亚洲使用的HCC的诊断和监测标志物，也已被证明是HCC的主要预后因素微血管浸润（MVI）的预测因子。然而，PIVKA-II在欧洲的经验仍然limited.Methods：在法国队列，我们进行了一项病例对照研究，比较甲胎蛋白（AFP）和PIVKA-II血清水平的早期HCC的诊断性能，我们确定的价值PIVKA-II血清和组织表达MVI术前检测。纳入43例肝硬化对照组和85例肝细胞癌患者，其中54例（63.5%）为早期肝细胞癌（极早期22例，早期32例）。结果：对于早期HCC的诊断，PIVKA-II的敏感性为77%，特异性为82%，截止值为42 mAU/ml，与AFP的61%和50%相比，截止值为5.5 ng/ml（AUC分别为0.81和0.58）。PIVKA-II水平> 90 mAU/ml是MVI的独立预测因子（HR 3.5; 95% CI 1.08-11.8; p = 0.043）。高PIVKA-II组织表达与MVI的存在显著相关（p = 0.001）。PIVKA-II免疫组化与血清PIVKA-II水平联合检测，诊断MVI的敏感性和特异性分别从70%提高到87%和63%提高到90%.Conclusions：PIVKA-II在早期HCC的诊断中比AFP更有效，可作为MVI的预测性生物标志物。(C)2015年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Prothrombin induced by vitamin K absence-II (PIVKA-II) is a diagnostic and surveillance marker for HCC mainly used in Asia, and has also been shown to be a predictor of microvascular invasion (MVI), a major prognostic factor in HCC. However, experience with PIVKA-II in Europe remains limited.Methods: In a French cohort, we conducted a case-control study to compare the performances of a-fetoprotein (AFP) and PIVKA-II serum levels for diagnosis of early stage HCC, and we determined the value of PIVKA-II serum and tissue expression in pre-operative detection of MVI. 43 cirrhotic control patients and 85 HCC cases were included, of which 54 (63.5%) had early stage HCC (n = 22 very early, n = 32 early). PIVKA-II tissue expression was assessed by immunohistochemistry in HCC surgical samples.Results: For the diagnosis of early HCC, PIVKA-II had a sensitivity of 77% and a specificity of 82% at a cut-off of 42 mAU/ml, vs. 61% and 50% for AFP at a cut-off of 5.5 ng/ml (AUC 0.81 vs. 0.58, respectively). A PIVKA-II level > 90 mAU/ml was an independent predictor of MVI (HR 3.5; 95% CI 1.08-11.8; p = 0.043). High PIVKA-II tissue expression was significantly associated with the presence of MVI (p = 0.001). When combining PIVKA-II immunostaining with the PIVKA-II serum level, sensitivity and specificity for the diagnosis of MVI increased from 70% to 87% and 63% to 90%, respectively.Conclusions: PIVKA-II was more efficient than AFP for the diagnosis of early HCC, and could be used as a predictive biomarker of MVI. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.