Clin Mol Hepatol.
2023 Apr;29(2):277-292. 10.3350/cmh.2022.0212.
Utility of combining PIVKA-II and AFP in the surveillance and monitoring of hepatocellular carcinoma in the Asia-Pacific region
- Kim DY1
- Toan BN2
- Tan CK3
- Hasan I4
- Setiawan L5
- Yu ML6,7
- Izumi N8
- Huyen NN9
- Chow PKH10,11
- Mohamed R12
- Chan SL13
- Tanwandee T14
- Lee TY15,16
- Hai TTN9,17
- Yang T18
- Lee WC19
- Chan HLY
20
- Affiliations
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- 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- 2Clinical Pathology Department, Medic Center, Ho Chi Minh, Vietnam
- 3Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- 4Faculty of Medicine, University Indonesia/Ciptomangunkusumo Hospital, Jakarta, Indonesia
- 5Clinical Pathology Department, Integrated Laboratory, Dharmais National Cancer Hospital, Jakarta, Indonesia
- 6Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- 7School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Koahsiung, Taiwan
- 8Japanese Red Cross Musashino Hospital, Musashino, Japan
- 9National Hospital for Tropical Diseases, Hanoi, Vietnam
- 10Department of Hepato-pancreato-biliary and Transplant Surgery, National Cancer Center Singapore and Singapore General Hospital, Singapore
- 11Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
- 12University Malaya Medical Centre, Kuala Lumpur, Malaysia
- 13State Key Laboratory of Oncology in South China, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
- 14Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- 15Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- 16Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- 17Biochemistry Department, Hanoi Medical University, Hanoi, Vietnam
- 18Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
- 19Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 20Department of Internal Medicine, The Chinese University of Hong Kong and Union Hospital, Hong Kong
- KMID: 2541406
- DOI: http://doi.org/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.
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