Application of PIVKA-IIand AFP in the diagnosis and therapeutic monitoring of hepatocellular carcinoma

Abstract

Objective To investigate the effect of protein induced by vitamine K absence or antagonist-Ⅱ(PIVKA-Ⅱ)and AFP on the diagnosis and therapeutic monitoring of hepatocellular carcinoma (HCC). Methods A total of 280 cases of liver diseases were selected, including 198 cases of HCC (60 cases of viral hepatitis, 98 cases of liver cirrhosis, 40 cases of other liver diseases) and 82 cases of HCC (52 cases in early stage, 30 cases in late stage), in the same period, 40 healthy people were selected from the department of laboratory for serological examination, the levels of PIVKA-Ⅱ and AFP in the serum of patients with liver disease and normal population were detected by an automatic immunoanalyzer. The ROC-AUC, sensitivity and specificity of PIVKA-Ⅱ and AFP were analyzed separately and jointly for the diagnosis of HCC. Results There were significant differences in PIVKA-Ⅱ and AFP between healthy control group and primary liver cancer group (early and late stage), viral hepatitis group, liver cirrhosis group and other liver disease group (P<0.05). The differences of PIVKA-Ⅱ and AFP among patients with primary liver cancer (early and late stage), and viral hepatitis group, liver cirrhosis group, other liver disease group and healthy control group were significant (P<0.05). And the difference of PIVKA-Ⅱ and AFP between the early primary liver cancer group and the advanced primary liver cancer group was significant (P<0.05). In the diagnosis by PIVKA-Ⅱ, 48 cases were not consistent with the results of gold standard, false positive in 24 cases, false negative in 24 cases, the sensitivity of the test results was 70.73%, specificity was 89.92%, accuracy was 85%; AFP alone, 74 cases were not consistent with the results of the gold standard, false positive in 41 cases, false negative in 33 cases, the sensitivity of the test results was 59.76%, specificity was 82.77%, accuracy was 76.88%; combined diagnosis scheme 1: there were 43 cases with the gold standard results, false positive in 4 cases, false negative in 39 cases, the sensitivity of the test results was 52.44%, specificity was 98.32%, accuracy was 86.56%; combined diagnosis scheme 2: there were 70 cases with the gold standard results, false positive in 56 cases, false negative in 14 cases, the sensitivity of the test results was 82.93%, specificity was 76.47%, the accuracy was 78.13% (combined diagnosis scheme 1 was as follows: when the joint diagnostic program was positive for all the two indexes, and HCC was the same as the one of the two indicators of the joint diagnostic program, which could be diagnosed as HCC). The sensitivity and specificity of PIVKA-Ⅱ test results were significantly better than those of AFP. The specificity of combined diagnostic scheme 1 and the sensitivity of the combined diagnostic scheme 2 was better than that of other tests. Conclusions PIVKA-Ⅱ detection is more valuable for the diagnosis of HCC than AFP, and PIVKA-Ⅱ combined with AFP for detecting HCC can significantly improve the sensitivity and specificity of the diagnosis. Key words: Protein induced by vitamine K absence or antagonist-Ⅱ; Alpha fetoprotein; Sensitivity; Specificity