PIVKA-II or AFP has better diagnostic properties for hepatocellular carcinoma diagnosis in high-risk patients


  • Tanita Suttichaimongkol Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
  • Manoon Mitpracha Division of Gastroenterology, Department of Medicine, Khon Kaen Regional Hospital, Khon Kaen - Thailand
  • Kawin Tangvoraphonkchai Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
  • Phuangphaka Sadeea Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
  • Kittisak Sawanyawisuth Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
  • Wattana Sukeepaisarnjaroen Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand




Hepatitis B virus, Hepatitis C virus, Sensitivity, Specificity


Background: Hepatocellular carcinoma (HCC) is a lethal cancer. Two biomarkers were used for HCC diagnosis including alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II or antagonist (PIVKA-II). However, data on biomarkers and HCC diagnosis are not consistent. This study aimed to evaluate if PIVKA-II, AFP, or a combination of both biomarkers had the best diagnostic properties for HCC.

Methods: This was a prospective study and enrolled patients 18 years or over with a high risk for HCC. AFP and PIVKA-II levels were calculated for HCC diagnosis. Diagnostic properties of both biomarkers were reported with sensitivity, specificity, and a receiver operating characteristic (ROC) curve.

Results: There were 260 patients with high risk for HCC in this cohort. Of those, 219 patients were diagnosed with HCC: confirmed by biopsy in 7 patients (2.69%) and by imaging in the others. Median values of AFP and PIVKA-II were 56 ng/mL and 348 mAU/mL, respectively. PIVKA-II level of 40 mAU/mL had sensitivity of 80.80%, while AFP of 10 ng/mL had sensitivity of 75.80%. A combination of PIVKA-II at 100 mAU/mL or over and AFP of 11 ng/mL gave sensitivity of 60.30%. The ROC curve of PIVKA-II plus AFP was significantly higher than the AFP alone (0.855 vs. 0.796; p = 0.027), but not significantly different from the PIVKA-II alone (0.855 vs. 0.832; p = 0.130).

Conclusion: PIVKA-II may have more diagnostic yield for HCC compared with AFP. It can be used alone without a combination with AFP.


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How to Cite

Suttichaimongkol, T., Mitpracha, M., Tangvoraphonkchai, K., Sadeea, P., Sawanyawisuth, K., & Sukeepaisarnjaroen, W. (2023). PIVKA-II or AFP has better diagnostic properties for hepatocellular carcinoma diagnosis in high-risk patients. Journal of Circulating Biomarkers, 12(1), 12–16. https://doi.org/10.33393/jcb.2023.2453



Original research article
Received 2022-07-08
Accepted 2023-02-01
Published 2023-02-17