PROTEIN-INDUCED BY VITAMIN-K ABSENCE OR ANTAGONIST-II AS A PROGNOSTICMARKER IN HEPATOCELLULAR-CARCINOMA - COMPARISON WITH ALPHA-FETOPROTEIN

Background. Protein induced by vitamin K absence or antagonist II (PIV KA-II) was widely used as a diagnostic marker for hepatocellular carci noma (HCC), however, its prognostic value is unclear. The authors eval uated PIVKA-II clinicopathologically as a prognostic marker for HCC. M ethods. The relationship between pathologic prognostic factors and pla sma PIVKA-II and alpha-fetoprotein (AFP) was investigated in 72 patien ts with resectable HCC measuring less than 6 cm in greatest dimension. Results. PIVKA-II shows significantly lower sensitivity, but higher s pecificity than AFP, and the use of these two complementary markers ap pears to be useful in the diagnosis of HCC. The frequencies of intrahe patic metastasis, portal vein tumor thrombus, hepatic vein tumor throm bus, and capsular infiltration were significantly higher in patients w ith positive PIVKA-II than in those with negative-PIVKA-II, and the re currence-free rate was significantly lower in patients with positive r ather than with negative PIVKA-II. However, there were no significant differences between the patients who were AFP positive and those who w ere AFP negative in pathologic prognostic factors and the recurrence-f ree rate. From univariate and multivariate analyses, the authors find that PIVKA-II is one of the risk factors for recurrence of HCC after h epatectomy. Conclusions. PIVKA-II may be a useful marker for the predi ction of intrahepatic spread and for the prognosis of HCC. In addition , PIVKA-II-positive patients, thus, need aggressive postoperative adju vant therapy for undetectable residual tumors and careful postoperativ e monitoring to enable the early recognition of recurrence.