ArticleWorld journal of gastrointestinal oncology2026
Serum protein induced by vitamin K absence or antagonist-II predicts aggressive tumor biology in alpha-fetoprotein-normal hepatocellular carcinoma.
Article in World journal of gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with hepatocellular carcinoma (HCC) beyond the Milan criteria or with portal vein tumor thrombosis are often excluded from the transplant list owing to aggressive biology and recurrence risk. While high alpha-fetoprotein (AFP) signals aggressiveness, the behavior of normal AFP HCC with elevated protein induced by vitamin K absence/antagonist-II (PIVKA-II) is less defined.
aimTo assess the prognostic value of PIVKA-II in normal AFP HCC.
methodsRetrospective cohort of 113 patients with normal AFP and normal or elevated PIVKA-II. "Aggressive" tumors were defined as beyond Milan and/or portal vein tumor thrombosis (
resultsThis study included 78 men and 35 women; mean age 58.4 ± 11.1 years; 62.8% with decompensated cirrhosis. PIVKA-II was higher in aggressive tumors: Median 2785 mAU/mL (interquartile range: 222-8152)
conclusionIn normal AFP HCC, PIVKA-II discriminates aggressive biology. A cut-off of 1609.5 mAU/mL balances sensitivity and specificity; 400 mAU/mL favors sensitivity; ≥ 4000 mAU/mL delineates an ultra-high-risk subgroup. Findings support the incorporation of PIVKA-II into risk stratification.
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