Indian journal of Medical Biochemistry

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VOLUME 23 , ISSUE 2 ( May-August, 2019 ) > List of Articles

RESEARCH ARTICLE

Evaluation of Diagnostic Utility of Protein Induced by Vitamin K Absence–II (PIVKA-II) in Hepatocellular Carcinoma

Siraj A Khan, Bhavya Sirivelu, KSS Saibaba, NN Sridevi, Krishnamohan Iyyapu

Keywords : Protein induced by vitamin K absence or antagonist II (PIVKA-II), Alpha-fetoprotein (AFP), Hepatocellular carcinoma (HCC), Hepatic Cirrhosis (HC), Receiver operating characteristic curve (ROC), Area Under Curve (AUC)

Citation Information : Khan SA, Sirivelu B, Saibaba K, Sridevi N, Iyyapu K. Evaluation of Diagnostic Utility of Protein Induced by Vitamin K Absence–II (PIVKA-II) in Hepatocellular Carcinoma. Indian J Med Biochem 2019; 23 (2):298-302.

DOI: 10.5005/jp-journals-10054-0107

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Cancer is one of the leading causes of death in both economically developed and developing countries. Among all the cancers, hepatocellular carcinoma (HCC) was a significant contributor being the fifth most prevalent and third leading global cause of deaths related to cancer. The most common biomarker use in its detection is Alpha-fetoprotein (AFP), but it has low sensitivity and specificity. Many other biomarkers have been evaluated for HCC detection, of which Protein Induced by Vitamin K Absence-II (PIVKA-II) is one, that showed elevated levels in these patients. So, we tried to evaluate the role of PIVKA-II in diagnosing HCC and its usefulness in differentiating HCC and Hepatic Cirrhosis (HC). The study group consisted of 70 patients with liver disease- 35 with HCC, 35 with cirrhosis; and 20 healthy study subjects who were age and gender matched. All patients and healthy subjects were evaluated for serum levels of both PIVKA-II and AFP. The median serum concentration of PIVKA-II in HCC, HC patients and healthy subjects were found to be 40.37 (23.3–79.38) ng/mL, 2.33 (1.03–3.72) ng/mL and 2.27 (0.12–12.87) ng/mL, respectively. To assess diagnostic utility, Receiver operating characteristic (ROC) curves plotted for both PIVKA-II and AFP. At a cut-off level of 6.715 ng/mL, PIVKA-II showed 85.71% sensitivity and 95.0% specificity, whereas AFP at a cut-off level of 11.8 ng/mL showed 77.14% sensitivity and 95% specificity. When both combined, their sensitivity increased to 94.29%. Also, there was a positive correlation of PIVKA-II levels with tumor size (p = 0.043), while no such significant association was found with AFP. Therefore, our study concludes that PIVKA-II is more sensitive than AFP in diagnosing HCC and differentiating it from Hepatic Cirrhosis; and when both combined, the sensitivity increased. Also, the positive correlation of Tumour size with PIVKA-II levels indicates that it may be useful in monitoring patients for progression of HCC.


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