Fulltext

Utility of combining PIVKA-II and AFP in the surveillance and monitoring of hepatocellular carcinoma in the Asia-Pacific region

Kim DY 1 , Toan BN 2 , Tan CK 3 , Hasan I 4 , Setiawan L 5 , Yu ML 6 Show all authors , Izumi N 7 , Huyen NN 8 , Chow PK 9 , Mohamed R 10 , Chan SL 11 , Tanwandee T 12 , Lee TY 13 , Hai TTN 8 , Yang T 14 , Lee WC 15 , Chan HLY 16

Affiliations 

  • 1 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2 Clinical Pathology Department, Medic Center, Ho Chi Minh, Vietnam
  • 3 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
  • 4 Faculty of Medicine, University Indonesia/Ciptomangunkusumo Hospital, Jakarta, Indonesia
  • 5 Clinical Pathology Department, Integrated Laboratory, Dharmais National Cancer Hospital, Jakarta, Indonesia
  • 6 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 7 Japanese Red Cross Musashino Hospital, Musashino, Japan
  • 8 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 9 Department of Hepato-pancreato-biliary and Transplant Surgery, National Cancer Center Singapore and Singapore General Hospital, Singapore
  • 10 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 11 State Key Laboratory of Oncology in South China, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
  • 12 Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 13 Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
  • 14 Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
  • 15 Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 16 Department of Internal Medicine, The Chinese University of Hong Kong and Union Hospital, Hong Kong
Clin Mol Hepatol, 2023 Apr;29(2):277-292.
PMID: 36710606 DOI: 10.3350/cmh.2022.0212

Abstract

Even though the combined use of ultrasound (US) and alpha-fetoprotein (AFP) is recommended for the surveillance of hepatocellular carcinoma (HCC), the utilization of AFP has its challenges, including accuracy dependent on its cut-off levels, degree of liver necroinflammation, and etiology of liver disease. Though various studies have demonstrated the utility of protein induced by vitamin K absence II (PIVKA-II) in surveillance, treatment monitoring, and predicting recurrence, it is still not recommended as a routine biomarker test. A panel of 17 experts from Asia-Pacific, gathered to discuss and reach a consensus on the clinical usefulness and value of PIVKA-II for the surveillance and treatment monitoring of HCC, based on six predetermined statements. The experts agreed that PIVKA-II was valuable in the detection of HCC in AFP-negative patients, and could potentially benefit detection of early HCC in combination with AFP. PIVKA-II is clinically useful for monitoring curative and intra-arterial locoregional treatments, outcomes, and recurrence, and could potentially predict microvascular invasion risk and facilitate patient selection for liver transplant. However, combining PIVKA-II with US and AFP for HCC surveillance, including small HCC, still requires more evidence, whilst its role in detecting AFP-negative HCC will potentially increase as more patients are treated for hepatitis-related HCC. PIVKA-II in combination with AFP and US has a clinical role in the Asia-Pacific region for surveillance. However, implementation of PIVKA-II in the region will have some challenges, such as requiring standardization of cut-off values, its cost-effectiveness and improving awareness among healthcare providers.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications