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

is deficient, and PIVKA-II is produced in large quantities combined diagnostic model can facilitate early diagnosis
due to cancer damage to hepatocytes. In recent years, the needs further clinical verification and adjustment.
Japanese Society of Hepatology, the Asia-Pacific Society However, this study is not without any shortcomings.
of Hepatology, the Chinese Medical Association, and This retrospective study may be prone to research biases,
other organizations have recommended PIVKA-II as warranting further verification of the results in the future
an early diagnostic indicator for HCC, and the China’s through randomized controlled trials. The patients
Chronic Hepatitis B Prevention and Treatment Guide with AFP-NHCC in this study were all recruited from a
(2019 edition) has identified PIVKA-II as an indicator single center, and the sample size was limited; therefore,
for screening and diagnosis of HCC in high-risk groups. more experimental subjects from different regions will be
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In foreign studies, PIVKA-II was superior to AFP in the needed in the future. The etiology of AFP-NHCC samples
screening and diagnosis of early HCC, and significantly was not classified in this study, and the diagnostic effect
superior to AFP in terms of sensitivity and specificity in of AFP-NHCC induced by different causes (viral hepatitis
disease monitoring and prognosis assessment. Tumor B infection, chemical or genetic factors, etc.) needs to be
staging determines the prognosis of all types of HCC. further evaluated.
The 5-year post-operative survival rate of HCC patients
diagnosed and treated early was found to exceed 70%, 5. Conclusion
indicating that an earlier diagnosis could extend the Through this study, we found that there were significant
median survival time of patients. In Table 2 and Figure 1, changes in PA, hs-CRP, NLR, and PIVKA-II in patients
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although the AUC of PIVKA-II for AFP-NHCC is smaller with AFP-NHCC compared with healthy individuals
than that of combined detection, it is still larger than and patients with benign lesions. Combined detection
0.5 with a sensitivity as high as 84.40%, but with a lower of laboratory indicators may facilitate early diagnosis of
specificity at only 73.80%. On the one hand, this index HCC with negative or normal AFP expression by affording
has a certain value for the diagnosis of AFP-NHCC; on higher diagnostic specificity and sensitivity, thereby
the other hand, compared with combined detection, the enabling early treatment of AFP-NHCC.
AUC area of PIVKA-II for AFP-NHCC is higher than that
of PIVKA-II for AFP-NHCC. In Table 3, we can see that Acknowledgments
the AUC of the three inflammatory indexes combined with
PIVKA-II was 0.895, and the specificity and sensitivity None.
were higher than that of the single detection, indicating Funding
that it is feasible to select PIVKA-II and inflammatory
indexes (PA, hs-CRP, and NLR) as screening means for This work was supported by the National Natural Science
patients with negative AFP but suspected with HCC. Foundation of China (Grant Nos. 31902287 and 81670988),
Satisfactory results of high sensitivity and high specificity the Kaifeng Science and Technology Development Plan
in the differential diagnosis can be obtained. At present, (Project No. 2203008), and the Cultivation Project for
there are many models for the diagnosis of AFP-NHCC Innovation Team in Teachers’ Teaching Proficiency by
by combined detection of multiple biomarkers, but they Zhengzhou Shu-Qing Medical College (No. 2024jxcxtd01).
are also subject to the influence of detection methods and Conflict of interest
threshold values. For example, the study of Zhang et al.
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showed that the combination of AFP-L3 and Golgi Protein Xin-Ying Ji is an Editorial Board Member of this journal
73 could improve the diagnostic accuracy and sensitivity but was not in any way involved in the editorial and
of AFP-NHCC (sensitivity 40.0%, specificity 100%, and peer-review process conducted for this paper, directly or
accuracy 76.9%). In addition, a review by Zhu et al. found indirectly. Separately, other authors declared that they
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that the AUC of AFP combined with platelet and alanine have no known competing financial interests or personal
aminotransferase ratio in differentiating AFP-NHCC relationships that could have influenced the work reported
(<20 ng/mL) from non-cancer control groups and chronic in this paper.
hepatitis B patients was 0.839 and 0.746, respectively. The
results showed that this model is an effective screening Author contributions
model for HCC with low or negative AFP levels. The Conceptualization: Zhi-Liang Jiang, Yi Liu
above studies all indicate that the combination of multiple Investigation: Huang-Yin Luo, De-Xin Zhang
biomarkers or the combination of new biomarkers with Methodology: Yi-Bin Lu
traditional indicators or laboratory routine indicators can Writing – original draft: Wen-Tan Hu, Ning Luo, Xin-Ying Ji
further improve diagnostic sensitivity. However, how the Writing – review & editing: All authors

Volume 3 Issue 4 (2024) 7 doi: 10.36922/gpd.4269