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KMID : 0882419930450010069
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Korean Journal of Medicine
1993 Volume.45 No. 1 p.69 ~ p.76
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PIVKA-2: The Significance as a New Tumor Marker for Hepatocellular Carcinoma
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최성호
신영민/김상현/박승근/이헌직/강대환/조 몽/양웅석/문한규
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Abstract
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ackground : AFP is known as one of the most sensitive tumor markers for hepatocellular carinoma. But in many cases of hepatocellular carcinoma, low or negative levels of AFP have been observed. And because AFP levels may be increased in cases of
other
liver diseases such as liver cirrhosis, its specificity and sensitivity are problems.
PIVKA-Ⅱ has been studied as a new tumor maker for hepatocellualr carcinom a with
AFP. It is a precursor protein of prothrombin and is converted to active form of prothrombin
by the action of Vitamin K dependent carboxylase in hepatocyte microsomes. As this process
can be suppressed by Vitamin K deficiency or Vitamin K antogonist such as warfarin,
PIVKA-Ⅱ levels might be increased due to functional derangement of Vitamin K-dependent
carboxylation in hepatocellular carcinoma. We measured the levels of PIVKA-Ⅱ in patients
with various liver diseases including hepatocellular carcinoma and evaluated the meaning of
increased PIVKA-Ⅱ levels.
Methods : We measured the levels of PIVKA-Ⅱ in the plasma of 30 patients with
hepatocellular carcinoma and 41 patients with other liver diseases by EIA method using
monoclonal antibody specific to PIVKA-Ⅱ. AFP was checked by RIA method.
Results : The levels of PIVKA-Ⅱ were increased above 0.1 AU/mL in the plasma of 25
(83%) patients with hepatocellular carcinoma and 1 patient with liver cirrhosis and 1 chronic
hepatitis, 1 receiving warfarin, 2 toxic hepatits, 2 cholangiocarcinoma and 1 liver metastatis
from stomach cancer.
In this study, with diagnostic cut-off value of 0.1 AU/mL, the sensitivity and specificity of
PIVKA-Ⅱ to detect hepatocellular carcinoma were 83.3% and 78% each. With cut-off value
of 8.0 AU/ml, the sensitivity and specificity were 66.7% and 100% each. By the combination
assay with the cut-off values of AFP above 100 ng/mL & PIVKA-Ⅱ above 0.1 AU/mL the
sensitivity for hepatocellular carcinoma could be elevated to 86.7%.
Conclusion : We can conclude that PIVKA-Ⅱ is more sensitive and specific than AFP and
is useful tumor marker which can elevate the sensitivity and specificity to detect
hepatocellular carcinoma by combination assay with AFP. And PIVKA-Ⅱ can be a useful
screening method to detect hepatocellular carcinoma arising from liver cirrhosis.
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KEYWORD
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