PIVKA-II level is correlated to development of portal vein tumor thrombus in patients with HBV-related hepatocellular carcinoma

Lei Wu,Yuanzi Yu,Tao Li,Shaocan Tang,Jingfang Zhao,Shengqing Gu,Meng Kong,Juan Liu,Yi Cui,Xiangguo Tian,Jinhua Hu

doi:10.1186/s13027-019-0229-6

Lei Wu, Yuanzi Yu + Show 9 more

Open Access

https://doi.org/10.1186/s13027-019-0229-6

Copy DOI

Abstract

AimTo evaluate the correlation of serum PIVKA-II levels and development of portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients.MethodsOne hundred and twenty-three patients with newly diagnosed HCC were included in this study between March 2016 and October 2018. Thirty-five of these patients were detected with PVTT and all subjects were randomly divided to analysis group (N = 73) and validation (N = 50) group. Serum levels of PIVKA-II, laboratory tests including serum aspartate aminotransferase, total bilirubin, platelet count, albumin levels were demonstrated in all the patients. T-test, chi-squared test and logistic regression was used for analyzing data. Diagnostic efficiency and cut-off value of PIVKA-II in PVTT development of HCC patients were calculated using receiver operator curve (ROC) analysis.ResultsSerum level of PIVKA-II in HCC patients with PVTT was significantly higher than that in HCC patients without PVTT (995.8 mAU/ml vs 94.87 mAU/ml; P = 0.003), as well as D-dimer levels (2.12 mg/L vs 0.56 mg/L P = 0.001). Univariate analysis showed that high serum D-dimer level was an independent risk factor for development of PVTT (OR = 1.22, 95%CI 1.02–1.45). ROC curve showed that among analysis group, the area under ROC curve (AUROC) of PIVKA-II was 0.73 (95%CI 0.59–0.86). For the detection of PVTT in HCC, PIVKA-II had a sensitivity of 83.7% and a specificity of 69.2% at a cutoff of 221.26 mAU/ml, which had a sensitivity of 85.71% and a specificity of 55.56% in validation group, respectively.ConclusionSerum PIVKA-II level is a potential marker for diagnosis of PVTT in HCC patients, which may guide therapeutic strategy and assessment of tumor prognosis of HCC.

Highlights

As the fifth most common cancer and the second highest cause of cancer-related death, hepatocellular carcinoma (HCC) is a severe health problem all over the world [1]
Prothrombin induced by vitamin K absence-II (PIVK A-II) is a prothrombin (PT) precursor with no coagulation activity secreted from HCC cells, and it has been shown to be a predictor of microvascular invasion (MVI) [5, 6]
Baseline characteristics and comparison of PIVKA-II levels in analysis group and validation group Thirty-five HCC patients with portal vein tumor thrombosis (PVTT) and 88 HCC patients without PVTT were enrolled in the present study between March 2016 and October 2018

Summary

Introduction

As the fifth most common cancer and the second highest cause of cancer-related death, hepatocellular carcinoma (HCC) is a severe health problem all over the world [1]. Serum levels of PIVKA-II have been demonstrated significantly increased in HCC patients and employed as a diagnostic marker in Asia [6, 7]. Several studies have revealed that PIVKA-II serum levels were significantly elevated in Eastern and European HCC patients [6, 8]. Higher PIVKA-II tissue expression was detected in HCC with microvascular invasion (MVI), as well as in serum [6]. It could be employed as a predictor of microvascular invasion [6]. The role of PIVK A-II in the development of macrovascular invasion such as PVTT is not well demonstrated

Objectives

Methods

Results

Conclusion