Value of serum PIVKA-Ⅱ, alpha-fetoprotein, and ferritin in assisting the diagnosis of HBV-related hepatocellular carcinoma

Objective To investigate the value of serum PIVKA-Ⅱ, alpha-fetoprotein ( AFP) , and ferritin ( FER) measured alone or in combination in assisting the diagnosis of HBV-related hepatocellular carcinoma ( HCC) . Methods A total of 40 patients with hepatitis B virus ( HBV) -related HCC, 41 patients with liver cirrhosis after hepatitis B, 44 patients with chronic hepatitis B ( CHB) , and 36 controls who underwent physical examination were enrolled. Their serum samples were collected and the serum levels of PIVKA-Ⅱ, AFP, and FER were measured. The area under the ROC curve ( AUC) , sensitivity, and specificity of PIVKA-Ⅱ, AFP, and FER measured alone or in combination in the diagnosis of HBV-related HCC were analyzed. The non-parametric Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups, and the Mann-Whitney U test was used for further comparison between two groups. A binary logistic stepwise regression analysis was used to determine the new variable pre of predicted probability of combined measurement of these three indices. Results There were significant differences in the serum levels of AFP and PIVKA-Ⅱ between the liver cirrhosis group, CHB group, HBV-related HCC group, and healthy control group ( χ2= 51. 446 and 59. 613, both P < 0. 001) . The HBV-related HCC group had a significantly higher serum level of AFP than the liver cirrhosis group, CHB group, and healthy control group ( Z =-4. 609, -6. 026, and-6. 031, all P < 0. 001) , and the liver cirrhosis group also had a significantly higher serum level of AFP than the healthy control group ( Z =-2. 30, P = 0. 021) . The HBV-related HCC group had a significantly higher serum level of PIVKA-Ⅱ than the liver cirrhosis group, CHB group, and healthy control group ( Z =-6. 080, -6. 595, and-5. 608, all P < 0. 001) , and the CHB group had a significantly higher serum level of PIVKA-Ⅱ than the healthy control group ( Z =-2. 153, P = 0. 031) . The HBV-related HCC group had a significantly higher serum level of FER than the CHB group ( Z =-2. 177, P = 0. 029) . When measured alone, AFP had the highest sensitivity in the diagnosis of HBV-related HCC ( 79. 49%) , and FER had the highest specificity ( 94. 28%) . When any two of these indices were measured, PIVKA-Ⅱ/AFP had the highest sensitivity ( 89. 74%) , and FER + AFP and FER + PIVKA-Ⅱ had a high specificity ( 97. 14%) . FER/AFP/PIVKA had a sensitivity of 92. 31% and the combined measurement of FER, AFP, and PIVKA-Ⅱhad a specificity of 97. 14%. Conclusion Combined measurement of PIVKA-Ⅱ, AFP, and FER can improve the sensitivity and specificity of single measurement. Serum PIVKA-Ⅱ and AFP have a high clinical value in the diagnosis of HCC; single measurement can well assist the diagnosis, and combined measurement does not increase the diagnostic rate.