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

lymphocytes using blood cell analyzer, and PIVKA-II the benign lesion group, with the healthy control group
by means of chemiluminescent particle immunoassay. recording the lowest levels; the differences were statistically
Afterward, the NLR was calculated. significant (P < 0.05) (Table 2).

2.5. Observation index 3.3. Performance analysis of different diagnostic
The laboratory test results of the three groups were methods
compared to analyze the diagnostic efficacy of the The diagnostic sensitivity and specificity of PIVKA-II were
inflammatory index combined with PIVKA-II, and 84.40% and 73.80% for AFP-NHCC, 56.70% and 68.87%
PIVKA-II alone, for AFP-NHCC. for hs-CRP, and 78.10% and 56.90% for PA, respectively.
The sensitivity and specificity of NLR were 75.00% and
2.6. Statistical analysis 47.80%, respectively. The sensitivity and specificity of
All the data were input into Statistical Package for Social combined diagnosis were 84.40% and 82.80%, and the area
Sciences (SPSS) 22.0 software (IBM SPSS Statistics, United under the curve (AUC) of combined diagnosis was larger
States of America) for processing. The whole variance (Figures 1 and 2, Table 3).
homogeneity test and normal distribution test were
performed on continuous data. Normally distributed 4. Discussion
data that meet homogeneous variance requirements are AFP is a typical and most widely used tumor marker for
expressed as mean ± standard deviation. One-way analysis all kinds of liver cancers, which is of great significance for
of variance was used for comparison among multiple disease diagnosis and prognosis monitoring. However,
23
groups, and the LSD-t test was used for comparison not all HCC patients will show increased AFP levels, and
between two groups. The non-normally distributed data it is worth noting that other types of liver injury (hepatitis,
are presented as median (M) and interquartile range (P25 cirrhosis, etc.) and even gastric cancer, teratoma, ovarian
and P75), and the comparison was performed using a non- tumor, and other diseases are accompanied by increased
parametric test. The diagnostic efficiency was analyzed AFP levels; this lack of disease specificity greatly limits
using the receiver operating characteristics (ROC) curve. the diagnostic value of AFP in HCC. Furthermore, the
P < 0.05 was considered statistically significant. application of AFP alone cannot meet the actual clinical

3. Result needs for HCC diagnosis. AFP-NHCC is a clinically special
type of HCC, which loses the expression of AFP during the
3.1. Comparison of baseline information early stage. 24
The age, gender, and living habits of the three groups The prognosis of HCC depends on the stage of the
of patients were found to be comparable (P >0.05). In tumor. In the Barcelona stage of liver cancer, liver cancer is
addition, there were no significant differences in the size of divided into very early stage, early stage, middle stage, late
the tumor, normal liver function, and presence or absence stage, and terminal stage. Patients with early-stage HCC
of liver cirrhosis between the AFP-NHCC group and the have a 5-year survival rate of more than 70%, whereas
benign lesion group (P > 0.05) (Table 1). symptomatic advanced patients have a median survival of
1.0 – 1.5 years after systemic therapy. In the very early stage,
3.2. Comparison of laboratory indexes patients usually have no related symptoms and signs, and
The levels of all inflammatory indexes and PIVKA-II only a single lesion of ≤2 cm is present at this time, with
were the highest in the AFP-NHCC group, followed by minimal liver function damage; therefore, early diagnosis

Table 2. Comparison of laboratory indexes
Group hs‑CRP (mg/L) PA (mg/L) NLR PIVKA‑\ (mAU/mL)
AFP-NHCC group (n=32) 74.65 (56.36, 129.43) a,b 45.71 (26.57, 67.46) a,b 3.59±1.58 a,b 814.27 (654.64, 978.46) a,b
Benign lesion group (n=58) 37.26 (28.67, 63.24) a 92.01 (55.67, 130.35) a 2.82±1.04 a 424.84 (316.65, 532.54) a
Healthy control group (n=45) 0.12 (0.06, 0.18) 241.15 (189.54, 290.67) 1.79±0.81 48.60 (20.04, 78.57)
χ 2 8.567 7.366 5.577 12.245
P <0.001 0.000 0.001 0.000
Notes: Data are expressed as either M (P25, P75) or mean±SD. P<0.05 compared with the healthy control group; P<0.05 compared with the benign
b
a
lesion group.
Abbreviations: AFP-NHCC: Alpha-fetoprotein-negative hepatocellular carcinoma; hs-CRP: High-sensitivity C-reactive protein; NLR: Neutrophil–
lymphocyte ratio; PA: Prealbumin.
Volume 3 Issue 4 (2024) 4 doi: 10.36922/gpd.4269