title: PIVKA-II is the best prognostic predictor in patients with hepatocellular carcinoma after radiofrequency ablation therapy.
abstract: OBJECTIVE
  This study was undertaken to assess the prognostic predictor in patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).
  
  
  METHODS
  This study retrospectively evaluated clinical outcomes in a cohort of 179 Child-Pugh stage A cirrhotic patients who received curative RFA for naive HCC within Milan criteria. The median follow-up period was 40.5 months.
  
  
  RESULTS
  The cumulative survival rate was significantly lower in patients with prothrombin induced by vitamin K absence or antagonist II (PIVKA-II) > or =100 mAU/ml compared with PIVKA-II <100 mAU/ml (58.0 vs. 84.0% at 5 years; p < 0.001). The cumulative recurrence-free survival rates were significantly lower in patients with PIVKA-II > or =100 mAU/ml compared with PIVKA-II <100 mAU/ml (12.1 vs. 16.9% at 5 years; p < 0.032). The cumulative rate of maintaining period within Milan criteria was significantly lower in patients with PIVKA-II > or =100 mAU/ml compared with PIVKA-II <100 mAU/ml (34.1 vs. 55.6% at 5 years; p < 0.001). Cox regression analysis showed that low serum albumin (<3.5 g/dl; p = 0.002, RR 3.75, CI 1.64-8.56), a high level of PIVKA-II (> or =100 mAU/ml; p = 0.04, RR 3.15, CI 1.45-6.87), and multiple nodules (p = 0.021, RR 2.61, CI 1.15-5.91) were independently significant mortality risk factors.
  
  
  CONCLUSIONS
  In patients with Child-Pugh stage A HCC, the PIVKA-II level is the best prognostic predictor after curative RFA.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Hobyung
authors.initials: H
authors.lastname: Chung
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Inoue
authors.forename: Emi
authors.initials: E
authors.lastname: Ishikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kitai
authors.forename: Chie
authors.initials: C
authors.lastname: Tatsumi
authors.forename: Taisuke
authors.initials: T
authors.lastname: Ueda
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nagai
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Minami
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Ueshima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000628:therapy; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin