The diagnostic performance of PIVKA-II in metabolic and viral hepatocellular carcinoma: A pilot study

Luca Miele, Gabriele Ciasca, Mariapaola Marino, Flavio Di Giacinto, Antonio Gasbarrini, Antonio Grieco, Umberto Basile, Cecilia Napodano, Krizia Pocino, Nicoletta De Matthaeis, Antonio Liguori, Giuseppe Marrone, Marco Biolato, Gian Ludovico Rapaccini, F. Gulli

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2 Citations (Scopus)


OBJECTIVE: Hepatocellular carcinoma (HCC) is a primary liver tumor derived from metabolic or viral chronic hepatitis, with few treatment options in advanced cases. New biomarkers that allow improving diagnosis and staging are widely desired. Here, we aim to evaluate the performance of Protein Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) in combination with α-fetoprotein (AFP), in the diagnosis of HCC in patients with metabolic or viral hepatitis. PATIENTS AND METHODS: We enrolled 60 HCC patients (20 metabolic and 40 viral) and 20 healthy subjects (HS) as negative controls. PIVKA- II, AFP, Matrix metalloproteinase-9 (MMP-9) and Fibroblast growth factor (FGF) serum levels were assessed by immunoassays. RESULTS: AFP and PIVKA-II levels were obviously higher in patients than in HS. AFP displayed a better diagnostic performance than PIVKA-II for viral HCC while PIVKA-II was better for metabolic HCC. The combination of the two biomarkers did not improve the discriminating ability. CONCLUSIONS: PIVKA-II may be considered an independent predictor of macrovascular invasion from HCC cells and it can be used to better stratify HCC patients and should be evaluated in prospective studies for early detection of advanced HCC in metabolic subjects.
Original languageEnglish
Pages (from-to)12675-12685
Number of pages11
JournalEuropean Review for Medical and Pharmacological Sciences
Publication statusPublished - 2020


  • Metabolic Hepatocellular carcinoma
  • Viral Hepatocellular carcinoma
  • α-fetoprotein


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