Ann Liver Transplant.  2022 May;2(1):34-42. 10.52604/alt.22.0012.

Diagnostic predictability of hepatocellular carcinoma tumor markers in patients waiting for living donor liver transplantation

• Park CS
• Chung YK
• Kang SH
• Hwang S

• KMID: 2560879
• DOI: http://doi.org/10.52604/alt.22.0012

Abstract

Background
This study analyzed the expression and diagnostic values of alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients who underwent living donor liver transplantation.
Methods
The number of patients with and without hepatocellular carcinoma (HCC) was 1,297 and 719 in hepatitis B virus (HBV) group; 128 and 90 in hepatitis C virus (HCV) group; 109 and 381 in alcoholic liver disease (ALD) group; and 61 and 306 in other disease group, respectively.
Results
In all patients, the median AFP and PIVKA-II were 9.0 ng/mL and 25 mAU/ mL in HCC patients and 4.0 ng/mL and 23 mAU/mL in non-HCC patients (p<0.001 for AFP and p=0.274 for PIVKA-II), respectively. In HBV patients, they were 9.0 ng/ mL and 24 mAU/mL in HCC patients and 4.6 ng/mL and 17 mAU/mL in non-HCC patients, respectively (p=0.002 and p=0.045). In HCV patients, they were 9.0 ng/ mL and 24 mAU/mL in HCC patients and 5.3 ng/mL and 24 mAU/mL in non-HCC patients, respectively (p=0.184 and p=0.216). In ALD patients, they were 6.2 ng/mL and 54 mAU/mL in HCC patients and 3.6 ng/mL and 48 mAU/mL in non-HCC patients, respectively (p<0.001 and p=0.456). In other disease patients, they were 9.9 ng/mL and 30 mAU/mL in HCC patients and 3.1 ng/mL and 25 mAU/mL in non-HCC patients, respectively (p<0.001 and p=0.190). A combination of 7.5 ng/mL for AFP cutoff or 40 mAU/mL for PIVKA-II cutoff resulted in sensitivity of 65.7%, specificity of 45.9%, positive predictive value of 56.4%, negative predictive value of 55.7%, and accuracy of 56.1%.
Conclusion
This study indicated that serum AFP and PIVKA-II may be expressed variably regardless of the background liver diseases. Serum PIVKA-II was highly expressed in liver cirrhosis patients with non-viral etiology. Therefore, the values of HCC tumor markers should be cautiously interpreted in liver transplant candidates.

Keyword

Hepatocellular carcinoma; Tumor marker; Tumor biology; Carcinogenesis; Viral hepatitis