Clinical relevance of pivka-ii after liver transplantation for hepatocellular carcinoma
Felipe Alconchel1,2, Francisco Villalba2, Luis Sáenz2,3, María Isabel Sánchez-Lorencio2, David Ferreras1,2, Pedro Antonio Cascales-Campos1,2, Beatriz Febrero1,2, Laura Martínez-Alarcón1,2, Marta Jover1,2, Francisco Sánchez-Bueno1,2, Ricardo Robles-Campos1,2, Pablo Ramírez1,2.
1Surgery and Organ Transplantation, Virgen de la Arrixaca University Hospital, Murcia, Spain; 2Biomedical Research Institute of Murcia (IMIB-Virgen de la Arrixaca), Murcia, Spain; 3Rafael Méndez Hospital, Lorca, Spain
Introduction: Measurement of fetoprotein (AFP) level is already used widely for routine surveillance and noninvasive HCC diagnosis and to evaluate prognosis and monitor recurrence. Serum prothrombin induced by the absence of vitamin K or antagonist-II (PIVKA-II) measurement more specifically differentiates HCC from other hepatic diseases. The objective of the current study was to assess clinical utility of PIVKA-II in patients with HCC.
Methods: Peripheral blood was obtained from 46 patients with HCC before transplantation (LT), at 6 months and 1 year post-LT. Serum PIVKA-II-levels were determined by Lumipulse G1200 (Fujirebio®) and serum AFP levels were obtained in Cobase601 (Roche Diagnostics®). The main clinicopathological variables were collected. Tumor size refers to the diameter in centimeters of the largest lesion at diagnosis as determined by pre-LT imaging. Spearman's rho, Mann- Whitney amd Wilcoxon test were used.
Results: Regarding the association between PIVKA-II and the other parameters, we found a statistically significant association with tumor size (rho=0,423; p=0,003). We also found significant differences in PIVKA-II levels between patients with tumor size ≤3 cm (median=74,50 mAU/mL; IR 37,50-155) and >3 cm (median=372,50 mAU/mL; IR 45,25-1422), such that median levels in patients with tumor size >3 cm were significantly higher (U=92; p=0,003). Finally, we found that PIVKA-II levels decreased significantly both at 6 months (Z= -2,814; p=0,005) and 1 year (Z= -2,315; p=0,021) after-LT.
Conclusions: PIVKA-II-levels were positively correlated with the the tumor size, suggesting that PIVKA-II may play a role in predicting the severity of the disease. A higher concentration of PIVKA-II may suggest a larger tumor volumen and a higher clinical stage. Also we found that the serum levels of PIVKA-II in HCC patients before and after LT had a significant difference, suggesting that PIVKA-II may be used as an indicator in evaluating curative effects of liver cancer surgery.
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