Cancer Medicine (Feb 2024)

Diagnostic accuracy of serum protein induced by vitamin K absence (PIVKA‐II), serum a‐fetoprotein and their combination for hepatocellular carcinoma among Caucasian cirrhotic patients with diagnostic or non‐diagnostic serum a‐fetoprotein levels

  • Antonia Syriha,
  • Spyridon Pantzios,
  • Dionysia Mandilara,
  • Petros Galanis,
  • Ioanna Stathopoulou,
  • Georgia Barla,
  • Ioannis Elefsiniotis

DOI
https://doi.org/10.1002/cam4.6825
Journal volume & issue
Vol. 13, no. 3
pp. n/a – n/a

Abstract

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Abstract Aim The aim of our study was to evaluate the accuracy of serum biomarkers (AFP/PIVKA‐II) and their combination in HCC diagnosis among Caucasian cirrhotic patients. Methods Serum AFP/PIVKA‐II levels were evaluated in 218 cirrhotics (163 males, 118 CTP‐A, 66 ALBI‐I, 111 with varices, 63 with diabetes) with (n = 90) or without (n = 128) HCC. Patients with HCC were categorized to BCLC Stage 0/A (n = 12), B (n = 21), C (n = 48), and D (n = 9). Results The two groups were comparable for all baseline parameters except for age, platelets, and diabetes presence. Median levels of AFP (239.1 vs. 4.0 ng/mL) and PIVKA‐II (4082.7 vs. 45.8 mAU/mL) were both significantly higher in HCC group compared to controls (p < 0.001). AUROC and cutoff value for HCC diagnosis were 88%/12.35 ng/mL (AFP) and 84.4%/677.13 mAU/mL (PIVKA‐II), whereas their combination showed better diagnostic accuracy (AUROC = 90.2%). The diagnostic accuracy of each biomarker separately was moderate or good in BCLC‐0/A/B and was excellent only for BCLC‐C patients (AFP: AUROC = 94.3%, cutoff = 12.35 ng/mL and PIVKA‐II: 91.3%, 253.51 mAU/mL) whereas their combination presented quite acceptable results in BCLC‐B (AUROC = 92.4%) and BCLC‐C (AUROC = 95.7%). Excluding HCC patients with high AFP (above 400 ng/mL), the diagnostic accuracy of each biomarker separately and their combination was moderate/good in all groups, except for their combination in BCLC‐C (AUROC = 90.5%). Conclusions Each biomarker separately showed acceptable accuracy for detecting HCC in cirrhotic patients and excellent for those in BCLC‐C stage. The combination of the biomarkers presented excellent results in BCLC‐B/C patients. The diagnostic accuracy of PIVKA‐II and the combination of the two biomarkers in patients expressing low/non‐diagnostic AFP levels was good in BCLC‐B and excellent in BCLC‐C patients.

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