title: Clinical usefulness of double biomarkers AFP and PIVKA-II for subdividing prognostic groups in locally advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  In this study, we investigated the clinical usefulness of AFP and PIVKA-II in subdividing prognostic groups in patients with locally advanced HCC treated locally.
  
  
  METHODS
  Patients who had undergone local treatment for locally advanced HCC between 2001 and 2006 were enrolled. Response to treatment was defined as a reduction in AFP or PIVKA-II by more than 50% from baseline levels at 1 month after the treatment completion. Patients were divided according to their AFP and PIVKA-II response: A↓P↓ [AFP response (+) and PIVKA-II response (+)]; A↓P↑ [AFP response (+) and PIVKA-II response (-)]; A↑P↓ [AFP response (-) and PIVKA-II response (+)]; A↑P↑ [AFP response (-) and PIVKA-II response (-)]. Clinical characteristics and prognosis were compared between groups.
  
  
  RESULTS
  Patients were subdivided into four groups by the change in the level of the biomarkers AFP and PIVKA-II, and the survival outcomes of each group were distinct. Among patients with an AFP response, further subdivision by PIVKA-II response revealed that those in the A↓P↓ group had a longer median progression-free survival (PFS) and overall survival (OS) compared with those in the A↓P↑ group (PFS: 16.2 vs. 5.1 months, P = 0.009; OS: 26.3 vs. 7.3 months, P = 0.017). Combination of AFP and PIVKA-II response showed a predictive power for PFS and OS comparable to radiological criteria and better than AFP response alone.
  
  
  CONCLUSIONS
  In patients with locally advanced HCC, the use of a combination of two biomarkers, AFP and PIVKA-II, appears useful in predicting treatment outcomes through the subdivision of prognostic groups.
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam-Si, Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hana
authors.initials: H
authors.lastname: Park
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Park
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D056910:Republic of Korea; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: C097353:AFP protein, human; D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: Alpha-foetoprotein; hepatocellular carcinoma; prothrombin induced by the absence of vitamin K or antagonist-II; tumour response