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Gene & Protein in Disease PIVKA-II in differential diagnosis of AFP-NHCC

2 Center for Molecular Medicine, Faculty of Basic Medical Subjects, Shu-Qing Medical College of Zhengzhou, Erqi District, Zhengzhou,
Henan, China
3 Department of Nuclear Medicine, Henan International Joint Laboratory for Nuclear Protein Regulation, the First Affiliated Hospital, Henan
University College of Medicine, Kaifeng, Henan, China
4 Kaifeng Municipal Key Laboratory for Infection and Biosafety, Henan International Joint Laboratory of Nuclear Protein Regulation, School
of Basic Medical Sciences, Henan University College of Medicine, Kaifeng, Henan, China
5 School of Clinical Medicine, Henan University, Kaifeng, Henan, China
6 School of Stomatology, Henan University, Kaifeng, Henan, China

1. Introduction with ultrasound, computed tomography does not
significantly improve the early detection rate. Magnetic
Primary liver cancer is a malignant tumor with high resonance imaging (MRI) boasts high sensitivity and
incidence and high mortality. There were 865,269 new specificity in the detection of early-stage liver cancer,
cases and 757,948 deaths of liver cancer in the world in but it is expensive and time-consuming. Therefore, it
7
2022, making it the sixth most common cancer and the is necessary to find a reliable, effective, and economical
third leading cause of death from cancer in the world. detection method for the diagnosis of AFP-NHCC in the
1
According to the data released by the International Agency early stage.
for Research on Cancer of the World Health Organization
(WHO), in 2020, there were 900,000 new cases of liver Previous studies showed that patients with liver cancer
cancer worldwide, of which 46% were documented in exhibited changes in a variety of laboratory indicators, such
9
8
China. The global death cases of liver cancer are 820,000, as blood cell counts, coagulation function, and serum
10
with China accounting for 47% of these cases. 2 enzyme levels. Recent years have seen the emergence
of clinical disease diagnosis models integrated with
In China, primary liver cancer mainly includes three laboratory data, which have obvious advantages including
pathological types: hepatocellular carcinoma (HCC), low cost and minimal invasiveness. 11,12 Therefore, the
intrahepatic cholangiocarcinoma, and mixed HCC- objective of this study was to examine the association
cholangiocarcinoma, among which 80% is HCC, which between specific clinical characteristics of AFP-NHCC
is the most common primary liver cancer, with most of patients and laboratory hematological parameters, such
the cases characterized by insipid onset and no specific as blood Vitamin K deficiency or antagonist-II inducer
symptoms in the early stage. Clinical detection of the protein (PIVKA-II), a novel marker for HCC screening,
disease presents substantial challenges since most of them which can effectively address the limitation of negative
are already in the middle and late stages when diagnosed, in AFP. It was observed that 63.2% – 76.3% of patients with
addition to the rapid progression, lower-efficacy treatment, negative AFP were positive for PIVKA-II; however, relying
and poor prognosis. According to the WHO, nearly half of solely on PIVKA-II detection could still result in missed
all cancers can be prevented; one-third of all cancers can diagnoses of early-stage patients with AFP-NHCC. 13
be detected early and diagnosed through cancer screening,
standing a higher chance for therapeutic cure. Therefore, In recent years, systemic inflammatory response
3
early screening of HCC plays a key role in improving the (SIR) has been proven to be an important distinguishing
feature of malignant tumors, and more and more studies
therapeutic efficacy and survival rate of patients. 4
have been conducted on inflammatory indicators in liver
Alpha-fetoprotein (AFP) is a proven blood biomarker lesions. It is generally believed that chronic inflammation
that is widely used in the clinical detection of liver cancer. is closely related to the occurrence and development of
AFP concentration increases after liver damage, which tumors. High-sensitivity C-reactive protein (hs-CRP),
14
is characterized by high diagnostic specificity and low an acute inflammatory protein, is mainly produced by
sensitivity. However, AFP levels are low in some patients the liver. Interleukin (IL)-1) and IL-6 can stimulate the
5
with liver cancer, a condition known as AFP-NHCC, which liver, increase CRP synthesis, and increase its blood level.
usually belongs to small liver cancer. Compared with HCC CRP is involved in multiple aspects of the inflammatory
with positive AFP expression, AFP-NHCC presents more process and is a key molecule linking innate immunity
diagnosis challenges and is mainly confirmed by means of and adaptive immunity. In addition to the increase of
imaging and pathologic tests. The efficacy of ultrasound CRP in acute infection and chronic infection, studies have
6
screening can be easily affected by the operator’s technique reported that CRP is also increased in a variety of cancers,
and inherent variations in individual subjects. Compared such as myeloma, ovarian cancer, urinary system tumors,

Volume 3 Issue 4 (2024) 2 doi: 10.36922/gpd.4269