title: Postoperative changes in protein-induced vitamin K absence or antagonist II levels after hepatectomy in patients with hepatocellular carcinoma: relationship to prognosis.
abstract: BACKGROUND
  alpha-Fetoprotein (AFP) has been used as a marker for hepatocellular carcinoma (HCC). However, AFP levels are often high in patients with chronic hepatitis or cirrhosis. Protein-induced vitamin K absence or antagonist II (PIVKA-II) is more sensitive for the diagnosis of HCC and prediction of patient survival. Changes in these markers after treatment may reflect treatment curability and patient outcome.
  
  
  METHODS
  We conducted a retrospective analysis of prognosis of 63 HCC patients with high preoperative levels of AFP and PIVKA-II who underwent hepatectomy and examined the relationship between postoperative changes in both markers at 1 month and patient survival. Subjects were divided into three groups according to changes in these tumour markers after hepatectomy: normalization (N) group, decreased but still above the normal level (D) group and unchanged (U) group.
  
  
  RESULTS
  There were no significant differences in the numbers of patients who developed tumour recurrence between changes in AFP and PIVKA-II. Survival analysis showed no significant differences in tumour-free and overall survivals between groups with respect to AFP level. The PIVKA-II-N group showed significantly better tumour-free and overall survival compared with the D and U groups (p<0.01). Multivariate analysis that included other prognostic factors identified changes in PIVKA-II level as a significant and independent prognostic factor associated with overall survival.
  
  
  CONCLUSIONS
  Although changes in AFP did not correlate with patient prognosis, normalization of PIVKA-II was significantly associated with good patient survival after hepatectomy. Normalization of PIVKA-II after hepatectomy reflected the efficacy of treatment and is a suitable predictor of prognosis in HCC patients.
authors.affiliation: Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Nanashima
authors.forename: Y
authors.initials: Y
authors.lastname: Sumida
authors.forename: S
authors.initials: S
authors.lastname: Tobinaga
authors.forename: K
authors.initials: K
authors.lastname: Shibata
authors.forename: H
authors.initials: H
authors.lastname: Shindo
authors.forename: M
authors.initials: M
authors.lastname: Obatake
authors.forename: S
authors.initials: S
authors.lastname: Shibasaki
authors.forename: N
authors.initials: N
authors.lastname: Ide
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu