Ann Surg Treat Res.  2022 Nov;103(5):271-279. 10.4174/astr.2022.103.5.271.

Prognostic value of preoperative protein-induced vitamin K absence or antagonist II after liver resection for hepatitis B-related hepatocellular carcinoma: a nationwide multicenter study

• Byun D
• Lee SG
• Kim H
• You Y
• Jung J
• Jang JH
• Lee MS
• Kim CN
• Cho BS
• Kang YJ
• on behalf of the Korean Liver Cancer Association

• KMID: 2534848
• DOI: http://doi.org/10.4174/astr.2022.103.5.271

Abstract

Purpose
Although protein-induced vitamin K absence or antagonist II (PIVKA-II) has been used as a diagnostic tool for hepatocellular carcinoma (HCC), its prognostic value remains unclear.
Methods
This was a nationwide multicenter study using the database of the Korean Liver Cancer Association. Patients with hepatitis B-related HCC who underwent liver resection as the first treatment after initial diagnosis (2008–2014) were selected randomly. Propensity score matching (1:1) was performed for comparative analysis between those with low and high preoperative PIVKA-II. Univariable and multivariable Cox proportional-hazards regression were used to identify prognostic factors for HCC-specific survival.
Results
Among 6,770 patients, 956 patients were included in this study. After propensity score matching, the 2 groups (n = 245, each) were well balanced. The HCC-specific 5-year survival rate was 80.9% in the low PIVKA-II group and 78.7% in the high PIVKA-II group (P = 0.605). In univariable analysis, high PIVKA-II (>106.0 mAU/mL) was not a significant predictor for worse HCC-specific survival (hazard ratio [HR], 1.183; 95% confidence interval [CI], 0.76–1.85; P = 0.461). In multivariable analysis, hyponatremia of <135 mEq/L (HR, 4.855; 95% CI, 1.67–14.12; P = 0.004), preoperative ascites (HR, 4.072; 95% CI, 1.59–10.43; P = 0.003), microvascular invasion (HR, 3.112; 95% CI, 1.69–5.74; P < 0.001), and largest tumor size of ≥5.0 cm (HR, 2.665; 95% CI, 1.65–4.31; P < 0.001), but not preoperative high PIVKA-II, were independent predictors for worse HCCspecific survival.
Conclusion
Preoperative PIVKA-II is not an independent prognostic factor for HCC-specific survival after liver resection for hepatitis B-related HCC.

Keyword

Biomarkers; Hepatectomy; PIVKA-II; Prognosis

Figure

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  Fig. 1 Study population. HCC, hepatocellular carcinoma; PIVKA-II, protein-induced vitamin K absence or antagonist II.

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  Fig. 2 Receiver-operating characteristic (ROC) curve analysis. PIVKA-II, protein-induced vitamin K absence or antagonist II.

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  Fig. 3 Survivals. (A) Overall survival in matched cohorts. (B) Hepatocellular carcinoma (HCC)-specific survival in matched cohorts. LP, low protein-induced vitamin K absence or antagonist II; HP, high protein-induced vitamin K absence or antagonist II.

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