title: [Optimal cut-off value of PIVKA-II for diagnosis of hepatocellular carcinoma--using ROC curve].
abstract: OBJECTIVE
  Protein induced by vitamin K absence or antagonist-II (PIVKA-II), also known as des-carboxyprothrombin (DCP), can be used as an alternative tool to alpha-fetoprotein (AFP) for surveillance of hepatocellular carcinoma (HCC). The aims of the present study were to compare PIVKA-II levels between the patients with HCC and patients with non-HCC chronic liver disease, to evaluate the correlation of PIVKA-II and AFP in HCC patients, and finally to estimate the optimal cut-off value for PIVKA-II for the diagnosis of HCC with using the receiver operating characteristic (ROC) curve.
  
  
  METHODS
  A total of 227 consecutive patients with HCC (n=42) or chronic liver disease (n=185) were enrolled in this study. HCC was diagnosed histologically or by imaging such as computed tomography, magnetic resonance imaging or angiography. The serum PIVKA-II and AFP levels were measured by electrochemiluminoimmunoassay with using the Haicatch PIVKA-II kit and by immunoradiometric assay, respectively.
  
  
  RESULTS
  The PIVKA-II level in the HCC patients was significantly higher than the non-HCC chronic liver disease patients (903.0+/-1156.7 vs. 111.7+/-211.0 mAU/ mL, respectively, P<0.01). PIVKA-II and AFP showed a statistical correlation in HCC patients (r=0.46, P<0.01). The sensitivity and specificity of PIVKA-II for the diagnosis of HCC were 66.7% and 74.1%, respectively, and when tasted together with AFP, the sensitivity was increased by 85.7%. For the ROC curve of PIVKA-II in HCC patients, the specificity of a 250 mAU/mL level of PIVKA-II was 95%.
  
  
  CONCLUSIONS
  PIVKA-II was as useful surveillance tool for differentiating HCC from chronic liver disease, and a PIVKA-II value of 250 mAU/ mL was proposed as a significant cut-off value for diagnosis of hepatocellular carcinoma.
authors.affiliation: Department of Internal Medicine, Dankook University College of Medicine, Choenan, Korea.
authors.forename: Myong Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Kang Woo
authors.initials: KW
authors.lastname: Bae
authors.forename: Pyoung Ju
authors.initials: PJ
authors.lastname: Seo
authors.forename: In Kook
authors.initials: IK
authors.lastname: Jeong
authors.forename: Jung Hyuk
authors.initials: JH
authors.lastname: Kim
authors.forename: Bo Han
authors.initials: BH
authors.lastname: Lee
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Bang
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Kim
authors.forename: Il Han
authors.initials: IH
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D012372:ROC Curve; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin