Abstract:

Objective To evaluate the application value of serum protein induced by Vitamin K absence or antagonist⁃Ⅱ（PIVKA ⁃Ⅱ）and alpha fetoprotein（AFP）in primary hepatocellular carcinoma（HCC）basing on decision curve analysis（DCA） and clinical impact curve method. Method A total of 982 cases of outpatients， inpatients and healthy controls in the First People′ s Hospital of Foshan were included，and divided into HCC group，chronic hepatitis B group，cirrhosis group，intrahepatic cholangiocarcinoma group，secondary hepatic malignant tumor group and control group. Serum PIVKA ⁃ Ⅱ and AFP levels were measured. Receiver operating characteristic（ROC），DCA and clinical impact curve were used to evaluate the application value of PIVKA ⁃Ⅱ and AFP in patients with HCC. Results The level of PIVKA⁃Ⅱ and AFP in HCC group was significantly higher than that in other groups（P < 0.001）. The level of PIVKA⁃Ⅱ and AFP in hepatitis group was significantly higher than that in control group（P < 0.001）. The proportion that PIVKA⁃Ⅱ and AFP increased inconsistently in HCC group，chronic hepatitis B group，and cirrhosis group was 35.44%，33.08%，and 35.43%，respectively. Taking patients without HCC as control group，the AUC of PIVKA⁃Ⅱ was better than that of AFP （P < 0.001），which was basically consistent with the joint detection（P = 0.967）. Taking healthy controls as control group，the AUC of joint detection was better than that of PIVKA⁃Ⅱ（P = 0.0385）and the AUC of PIVKA⁃Ⅱ was better than that of AFP（P < 0.001）. Combined with age and gender，the diagnostic value of joint detection for HCC was better than that of AFP. Except for the risk threshold of 0.24 ~ 0.25，the diagnostic value of combined detection was also better than that of PIVKA⁃Ⅱ. When the threshold probability was 0.2， the number of people classified as high risk by thejoint detection scheme was basically consistent with that of true⁃positive patients. Conclusion Serum PIVKA⁃Ⅱ and AFP are good biomarkers for the diagnosis of HCC. In the early screening and diagnosis of HCC，the factors such as patient′s gender，age，PIVKA⁃Ⅱ and AFP level should be taken into consideration in the analysis.

Key words:

hepatocellular carcinoma, decision curve analysis, protein induced by vitamin K absence or antagonist?Ⅱ, alpha?fetoprotein