Hepatocellular carcinoma (HCC) is a significant health concern, with a high mortality rate, and is the most common type of cancer in Thailand. Early-stage liver cancer often presents no symptoms, and many patients are only diagnosed at an advanced stage when the disease has already spread.
Early detection of liver cancer is crucial as it increases the chances of a cure through surgical intervention.Previously, liver cancer screening relied on ultrasound combined with AFP (alpha-fetoprotein) marker tests for at-risk individuals. However, AFP levels often remain normal in patients with early-stage liver cancer. A new biomarker, PIVKA-II, has shown improved accuracy in detecting early-stage liver cancer compared to AFP alone. The sensitivity of AFP alone in predicting liver cancer is approximately 55%, but combining AFP with PIVKA-II increases sensitivity to 72%.
What is Hepatocellular Carcinoma (HCC)?
Hepatocellular carcinoma arises from abnormal mutations and uncontrolled growth of liver cells. Most HCC cases develop in individuals with pre-existing liver conditions, such as:
- Cirrhosis of the liver, caused by:
- Chronic alcohol consumption.
- Hepatitis B or C infections.
- Non-alcoholic fatty liver disease (NAFLD).
- In some cases, patients with chronic hepatitis B or fatty liver disease can develop liver cancer even without cirrhosis.
What is PIVKA-II Liver Cancer Screening?
PIVKA-II (Protein Induced by Vitamin K Absence or Antagonist-II) is a protein-based biomarker used to detect liver cancer in its early stages. This test is more effective than AFP alone in diagnosing hepatocellular carcinoma.
PIVKA-II Testing with AFP
- PIVKA-II and AFP levels are analysed along with factors such as sex and age.
- The GALAD Score (ranging from 0 to 10) is calculated to assess the risk of HCC. A cut-off value of 2.57 indicates a higher likelihood of HCC, allowing for earlier and more accurate screening.
Who Should Be Screened?
The PIVKA-II test is recommended for individuals at risk of liver cancer, including:
- Those with liver cirrhosis or fibrosis.
- Individuals with high-risk hepatitis B infection, such as:
- Men over 40 years old.
- Women over 50 years old.
- People with a family history of liver cancer.
Precautions for PIVKA-II Testing
- Medications containing vitamin K may decrease PIVKA-II levels.
- Vitamin K antagonists (e.g., warfarin) and conditions causing vitamin K deficiency, such as biliary obstruction, may lead to elevated PIVKA-II values.
- PIVKA-II testing should not be performed in patients currently receiving vitamin K-active drugs.
- Elevated PIVKA-II levels in patients with kidney abnormalities should be assessed alongside blood creatinine tests.
Importance of PIVKA-II testing
Early-stage HCC has often no symtomps.Using PIVKA-II alongside AFP significantly enhances the accuracy of HCC screening. Early detection of liver cancer allows for timely intervention, improving patients’ chances of recovery and long-term survival.
References
- McGlynn, K.A.; Petrick, J.L.; El-Serag, H.B. Epidemiology of Hepatocellular Carcinoma. Hepatology, 2021, 73 (Suppl. 1), 4–13.
- Guyan, M. et al. The Performance of GALAD Score for Diagnosing Hepatocellular Carcinoma in Patients with Chronic Liver Diseases: A Systematic Review and Meta-Analysis. J. Clin. Med., 2023, 12, 949.
- Llovet, J.M. et al. Hepatocellular Carcinoma. Nat Rev Dis Primers, 2021, 7, 6.
- Sachan, A.; Kushwah, S.; Duseja, A. GALAD Score for HCC Screening and Surveillance. Clin. Gastroenterol. Hepatol., 2023, 21, 556–557.
