Clinical utility of prothrombin induced by vitamin K absence in the detection of hepatocellular carcinoma in Indian population.
BACKGROUND
Alpha-fetoprotein (AFP) is a well known widely used biomarker for the detection of hepatocellular carcinoma (HCC); however, it suffers from a low sensitivity and specificity. Protein or prothrombin induced by vitamin K absence or antagonist II (PIVKA-II) is another tumor marker elevated in HCC but not extensively used.


OBJECTIVE
Evaluation of PIVKA-II and AFP in diagnosing HCC in India.


METHODS
The study group consisted of 70 consecutive HCC patients, 38 patients with cirrhosis, 30 patients with chronic hepatitis, and 30 normal healthy subjects. All patients were evaluated for PIVKA-II and AFP levels by ELISA.


RESULTS
The mean plasma concentration of PIVKA-II in HCC, cirrhotic, chronic hepatitis patients and healthy controls was 101.07 ± 78.30 ng/ml, 2.45 ± 4.25 ng/ml, 1.50 ± 0.98 ng/ml and 0.79 ± 0.75 ng/ml, respectively. Receiver operating characteristic (ROC) curve was plotted for PIVKA-II and AFP. At a cutoff level of 9.2 ng/ml for PIVKA-II a sensitivity of 80% and a specificity of 92.1% was found, whereas AFP at a cutoff level of 13.02 ng/ml showed 72.9% sensitivity and 65.8% specificity. No significant relationship of plasma levels of PIVKA-II was observed in HCC with HBsAg/antiHCV positivity and associated portal vein thrombosis, but a positive correlation was seen with the tumor size (P = 0.001). However, no such significant association was found with AFP.


CONCLUSIONS
PIVKA-II was more sensitive and specific than AFP for diagnosing HCC in the Indian population.
Balkrishan
B
Sharma
Radhika
R
Srinivasan
Yogesh Kumar
YK
Chawla
Shweta
S
Kapil
Nitin
N
Saini
Bhupesh
B
Singla
Anuradha
A
Chakraborthy
Naveen
N
Kalra
Ajay
A
Duseja
Radha Krishan
RK
Dhiman