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

of HCC can provide the opportunity for timely treatment, very early-, early-, and even middle-stage liver cancer is
thereby improving the survival rate of patients. Therefore, not high in China, and the reasons are as follows 26-28 ; the
the clinical consensus is that very early intervention is the pre-cancerous lesion of HCC, in which a nodule is formed
best treatment strategy. However, the diagnosis rate of from the proliferation of a single hepatocyte clone has
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abnormal cytology and histology, but does not meet HCC
criteria; HCC is divided into low- and high DNA, there is
no clear distinction between atypical hyperplastic nodules
DNA and HCC. Although MRI and other high-resolution
examination methods can increase the detection probability
of small lesions, these techniques are not feasible during
the 1 -time screening due to high cost and other inherent
st
problems. The early-stage condition of certain patients
lacks specificity and also demonstrates low awareness of
the need for active examination. The diagnostic efficacy
of AFP cannot meet the actual needs of clinical practice,
and there is a greater possibility of false positive and false
negative results which ultimately lead to the progress
of liver cancer patients in the middle and late stage or
Figure 1. Diagnostic ROC curve of PA, PIVKA-II, and all inflammatory terminal stage at the time of diagnosis, which is extremely
indexes for AFP-NHCC unfavorable to their treatment and quality of life. With
Abbreviations: AFP-NHCC: Alpha-fetoprotein-negative hepatocellular
carcinoma; PA: Prealbumin; ROC: Receiver operating characteristics. the progress of medical technology and human society,
laboratory examination of tumor markers supported by
bioinformatics technology has become a global research
hotspot on the grounds of their minimal invasiveness and
the reproducibility nature of results. The occurrence and
development process of most tumors shares very similar
characteristics, and more and more studies have been
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conducted regarding the impact of chronic inflammation
on the occurrence and development of tumors. Due to
the low effectiveness and prolonged time required in the
detection methods employing most inflammatory indexes,
many researchers have become more interested in using
tumor markers and inflammatory indicators with high
specificity, high accuracy, and high sensitivity for tumor
screening and diagnosis.
As can be seen from Table 1, the hs-CRP, PA, NLR, and
Figure 2. Diagnostic ROC curve of hs-CRP, NLR, and PIVKA-II for AFP- PIVKA-II of patients in the benign lesion group and the
NHCC AFP-NHCC group were higher than those in the healthy
Abbreviations: AFP-NHCC: Alpha-fetoprotein-negative hepatocellular
carcinoma; hs-CRP: High-sensitivity C-reactive protein; NLR: control group, and the levels of the above indicators in
Neutrophil-lymphocyte ratio; ROC: Receiver operating characteristics. the AFP-NHCC group were also higher than those in the

Table 3: Performance analysis of different diagnostic methods

Diagnostic mode AUC Standard P 95% confidence Sensitivity Specificity Youden Cut‑off
error interval index value
PIVKA-II 0.858 0.037 <0.001 0.786 – 0.930 84.40 73.80 0.582 602.16
hs-CRP 0.843 0.046 <0.001 0.754 – 0.933 56.78 68.87 0.61 59.06
PA 0.671 0.059 0.007 0.557 – 0.786 78.10 56.90 0.35 53.57
NLR 0.736 0.053 <0.001 0.632 – 0.840 75.00 72.80 0.478 1.36
PIVKA-II + inflammatory indexes 0.895 0.036 <0.001 0.825 – 0.965 84.40 82.80 0.672 -
Abbreviations: AUC: Area under the curve; hs-CRP: High-sensitivity C-reactive protein; NLR: Neutrophil-lymphocyte ratio; PA: Prealbumin.

Volume 3 Issue 4 (2024) 5 doi: 10.36922/gpd.4269