Value of serum alpha-fetoprotein and protein induced by vitamin K absence or antagonist-Ⅱ in pathological diagnosis of hepatocellular carcinoma

Objective To investigate the value of serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-Ⅱ) in the pathological diagnosis of hepatocellular carcinoma (HCC) .Methods A retrospective analysis was performed for the clinical data of 134 patients with malignant liver tumors who underwent ultrasound-guided liver biopsy in Minimally Invasive Interventional Center of Oncology, Beijing You An Hospital, from May 2016 to December 2016, and among these patients, 103 had pathologically confirmed HCC and 31 did not have HCC.A statistical analysis was performed for the measurements of serum AFP and PIVKA-Ⅱ.The Mann Whitney U test was used for comparison between two groups.The Spearman rank correlation analysis was used to analysis the correlation between AFP and PIVKA-Ⅱ.The ROC curve was used to evaluate the efficiency of AFP and PIVKA-Ⅱ in the diagnosis of HCC in patients with malignant liver tumors.Sensitivity and specificity were calculated, and the area under the ROC curve (AUC) was calculated.The Z test was used for the comparison of AUC.Results The HCC group had significantly higher serum levels of AFP and PIVKA-Ⅱ than the non-HCC group (all P<0.001) .Serum AFP had an AUC of 0.842 in the diagnosis of HCC, PIVKA-Ⅱ had an AUC of 0.863, and combined determination of AFP and PIVKA-Ⅱ had an AUC of 0.869;there was a significant difference in AUC between them (all P<0.001) .Serum AFP alone had a sensitivity of 70.9% and a specificity of 90.3%, PIVKA-Ⅱ alone had a sensitivity of 72.8% and a specificity of 77.4%, and combined determination of AFP and PIVKA-Ⅱ had a sensitivity of 82.5% and a specificity of 77.4%.In HCC patients, serum AFP was significantly correlated with PIVKA-Ⅱ (r=0.207, P<0.05) .Conclusion Serum AFP and PIVKA-Ⅱ have a high clinical value in the differential diagnosis of HCC in patients with malignant liver tumors.PIVKA-Ⅱ measured alone has a higher efficiency than AFP, and serum AFP and PIVKA-Ⅱ measured in combination have a higher efficiency than AFP or PIVKA-Ⅱ measured alone.Serum AFP and PIVKA-Ⅱ can provide a basis for preliminary judgment of pathological type in patients who refuse to undergo liver biopsy and help with the selection of standard therapeutic regimens and evaluation of clinical prognosis.