title: Diagnostic value of PIVKA-II and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma.
abstract: OBJECTIVE
  To determine the cutoff values and to compare the diagnostic role of alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) in chronic hepatitis B (CHB).
  
  
  METHODS
  A total of 1255 patients with CHB, including 157 patients with hepatocellular carcinoma (HCC), 879 with non-cirrhotic CHB and 219 with cirrhosis without HCC, were retrospectively enrolled. The areas under the receiver operating characteristic (AUROC) curves of PIVKA-II, AFP and their combination were calculated and compared.
  
  
  RESULTS
  The optimal cutoff values for PIVKA-II and AFP were 40 mAU/mL and 10 ng/mL, respectively, for the differentiation of HCC from nonmalignant CHB. The sensitivity and specificity were 73.9% and 89.7%, respectively, for PIVKA-II and 67.5% and 90.3% for AFP, respectively. The AUROC curves of both PIVKA-II and AFP were not significantly different (0.854 vs 0.853, P = 0.965) for the differentiation of HCC from nonmalignant CHB, whereas the AUROC of PIVKA-II was significantly better than that of AFP in patients with cirrhosis (0.870 vs 0.812, P = 0.042). When PIVKA-II and AFP were combined, the diagnostic power improved significantly compared to either AFP or PIVKA-II alone for the differentiation of HCC from nonmalignant CHB (P < 0.05), especially when cirrhosis was present (P < 0.05).
  
  
  CONCLUSIONS
  Serum PIVKA-II might be a better tumor marker than AFP, and its combination with AFP may enhance the early detection of HCC in patients with CHB.
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Seung In
authors: SI
authors: Seo
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Hyoung Su
authors: HS
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Won Jin
authors: WJ
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Woon Geon
authors: WG
authors: Shin
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Doo Jin
authors: DJ
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Kyung Ho
authors: KH
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Myoung Kuk
authors: MK
authors: Jang
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Jin Heon
authors: JH
authors: Lee
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Joo Seop
authors: JS
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Hak Yang
authors: HY
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Dong Joon
authors: DJ
authors: Kim
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Myung Seok
authors: MS
authors: Lee
authors: Seung In Seo, Hyoung Su Kim, Won Jin Kim, Woon Geon Shin, Kyung Ho Kim, Myoung Kuk Jang, Jin Heon Lee, Hak Yang Kim, Dong Joon Kim, Myung Seok Lee, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Seoul 134-701, South Korea.
authors: Choong Kee
authors: CK
authors: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000201:enzymology / Q000821:virology; D055088:Early Detection of Cancer; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000097:blood* / Q000201:enzymology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult; 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-fetoprotein; Hepatitis B virus; Hepatocellular carcinoma; Prothrombin induced by vitamin K absence-II