title: Protein induced by vitamin K absence or antagonist-II (PIVKA-II) specifically increased in Italian hepatocellular carcinoma patients.
abstract: OBJECTIVE
  As a marker for Hepatocellular Carcinoma (HCC), Protein Induced by Vitamin K Absence II (PIVKA-II) seems to be superior to alpha fetoprotein (AFP). To better characterize the role of PIVKA-II, both AFP and PIVKA-II have been measured in Italian patients with diagnosis of HCC compared with patients affected by non-oncological liver pathologies.
  
  
  METHODS
  Sixty serum samples from patients with HCC, 60 samples from patients with benign liver disease and 60 samples obtained from healthy blood donors were included in the study. PIVKA-II and AFP were measured by LUMIPULSE(®) G1200 (Fujirebio-Europe, Belgium). We considered as PIVKA-II cutoff 70 mAU/ml (mean +3SD) of the values observed in healthy subjects.
  
  
  RESULTS
  The evaluation of PIVKA-II showed a positivity of 70% in patients with HCC and 5% in patients with benign diseases (p < 0.0001) whereas high levels of AFP were observed in 55% of HCC patients and in 47% of patients with benign diseases. The combined Receiver Operating Characteristic (ROC) analysis of the two analytes revealed a higher sensitivity (75%) compared to those observed for the individual biomarkers. In conclusion, we demonstrate that as a marker for HCC, PIVKA-II is more specific for HCC and less prone to elevation during chronic liver diseases.
  
  
  CONCLUSIONS
  The combination of the two biomarkers, evaluated by the ROC analysis, improved the specificity compared to a single marker. These data suggest that the combined analysis of the two markers could be a useful tool in clinical practice.
authors.affiliation: a Department of Molecular Medicine , "Sapienza" University of Rome , Roma , Italy ;
authors.forename: Valentina
authors.initials: V
authors.lastname: Viggiani
authors.affiliation: a Department of Molecular Medicine , "Sapienza" University of Rome , Roma , Italy ;
authors.forename: Sara
authors.initials: S
authors.lastname: Palombi
authors.affiliation: a Department of Molecular Medicine , "Sapienza" University of Rome , Roma , Italy ;
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Gennarini
authors.affiliation: b Department of Public Health and Infectious Diseases , ''Sapienza'' University of Rome , Roma , Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: D'Ettorre
authors.affiliation: b Department of Public Health and Infectious Diseases , ''Sapienza'' University of Rome , Roma , Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: De Vito
authors.affiliation: a Department of Molecular Medicine , "Sapienza" University of Rome , Roma , Italy ;
authors.forename: Antonio
authors.initials: A
authors.lastname: Angeloni
authors.affiliation: a Department of Molecular Medicine , "Sapienza" University of Rome , Roma , Italy ;
authors.forename: Luigi
authors.initials: L
authors.lastname: Frati
authors.affiliation: a Department of Molecular Medicine , "Sapienza" University of Rome , Roma , Italy ;
authors.forename: Emanuela
authors.initials: E
authors.lastname: Anastasi
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* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: AFP; PIVKA-II; benign liver diseases; hepatocellular carcinoma; tumor marker