The Clinical Value Of Serum PIVKA-â…¡ And AFP Detection For Hepatocellular Carcinoma

Objective: To discuss the clinical value of Protein induced by Vitamin K Antagonist-II( PIVKA-II) and alpha-Fetoproteins(AFP) in diagnosing hepatocellular carcinoma( HCC) and monitoring the treatment effects.Methods: Patients were recruited by the Affiliated Hospital of Qingdao University,from August 2013 to March 2014. Serum levels of PIVKA-II and AFP were measured by both chemiluminescence assay( CLIA) and electrochemiluminescence assay( ECLA) in patients with HCC( n=148), intrahepatic cholangiocellular carcinoma( n=37), gastric cancer and colorectal cancer( n=44), cirrhosis( n=63), chronic hepatitis B( n=38) and healthy subjects( n=57). To analyze the areas under the receiver operating characteristic curves( ROC-AUC) and to compare the sensitivity and specificity of single PIVKA-II or AFP assay, and the combined detection. To analyze the correlation of PIVKA-II and both tumor size and TNM staging, so do AFP, respectively. To compare the serum level changes of the two indicators in HCC patients before and after treatment.Results: The serum levels of both PIVKA-II and AFP in HCC group were higher than that in intrahepatic cholangiocellular carcinoma, gastric cancer and colorectal cancer,cirrhosis, chronic hepatitis B and healthy subjects groups( PIVKA-II:U = 866.50, 424.00,958.00, 292.00 and 448.00; AFP:U = 713.00, 440.50, 1182.00, 614.00 and 399.00, P <0.001). The ROC-AUCs of the single PIVKA-II or AFP assay and the combined detection in HCC group were not statistically different( P > 0.05). The sensitivity of PIVKA-II(87.16%) was higher than that of AFP(68.92%,χ2 = 4.73,P < 0.05)in diagnosing HCC; the sensitivity of the combined detection of PIVKA-II and AFP(93.24%)was higher than that of PIVKA-II itself(87.16%,adjusted χ2 = 64.70,P <0.01); while the specificities among them did not show statistical significance( P >0.05). Tested by Spearman rank correlation, the serum levels of PIVKA-II and AFP were both positively related to tumor size( r = 0.716, 0.475 respectively, P < 0.001).The serum levels of PIVKA-II and AFP in HCC patients increased gradually correlated with tumor size( H = 72.70, 37.02 respectively, P < 0.001) and the positive rates of PIVKA-II and AFP were gradually improved( χ2= 26.74, 21.62 respectively, P <0.01), too. Based on the International TNM Staging System, the serum levels of PIVKA-II and AFP( H = 46.63, 21.38 respectively, P < 0.001) and the positive rates of PIVKA-II and AFP( PIVKA-II:χ2 = 20.40,P < 0.01;AFP: χ2 = 8.33,P < 0.05) in HCC patients fromⅠ~Ⅳ stages were increased as TNM stages elevated. The serum levels of PIVKA-II and AFP in HCC patients were both dropped sharply compared with preoperative levels( Z =-4.59,-4.22 respectively, P < 0.001) and also both dropped in each of theⅠ~Ⅳ TNM stages( PIVKA-II: Z =-2.85、-2.98、-2.70 respectively, P < 0.05;AFP: Z =-2.48、-3.82、-2.50 respectively, P < 0.05) compared with serum levels before treatment.Conclusion: PIVKA-II and AFP both have high clinical application values in diagnosing HCC and monitoring treatment effects; the sensitivity of PIVKA-II in diagnosing HCC is significantly higher than AFP, and the sensitivity can be elevated by the combined detection in diagnosing HCC without reducing the specificity.