ArticleJournal of hepatocellular carcinoma2026
Prognostic Significance of Combined α-Fetoprotein and PIVKA-II for Hepatocellular Carcinoma After Hepatectomy.
Article in Journal of hepatocellular carcinoma, 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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6 authors.
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Abstract
Purpose: Hepatocellular carcinoma (HCC) exhibits notable prognostic heterogeneity. While AFP is a routine HCC prognostic biomarker, its limited detection rate restricts standalone use. This study aimed to evaluate the prognostic value of combined preoperative AFP and PIVKA-II for postoperative outcomes in HCC patients undergoing hepatectomy. Patients and Methods: A total of 553 patients were retrospectively enrolled and stratified into double-positive (DP), single-positive (SP), and double-negative (N) groups based on preoperative AFP (>400 ng/mL) and PIVKA-II (>40 ng/mL) levels. Kaplan-Meier survival curves assessed overall survival (OS) and recurrence-free survival (RFS). Univariate and multivariate Cox models identified independent clinicopathological survival predictors. Results: The N group demonstrated significantly better OS and RFS rates at 1 and 2 years than the SP group, while the DP group exhibited the poorest outcomes. Multivariate Cox regression analysis identified tumor size >5 cm and PIVKA-II >40 ng/mL as independent risk factors for both OS and RFS. Moreover, advanced age (>60 years) and multiple tumors (≥2) were independently associated with poorer OS, whereas tumor size ≥5 cm, BCLC stage C, and AFP >400 ng/mL were independent predictors of reduced RFS. The combined AFP/PIVKA-II stratification exhibited good prognostic discriminative ability for postoperative survival, with a C-index of 0.728 (95% CI: 0.650-0.806), but single biomarkers maintained independent prognostic power. Conclusion: Based on the independent prognostic value of individual biomarkers, combined evaluation of AFP and PIVKA-II provides a supplementary tool to refine postoperative risk stratification for HCC patients after hepatectomy.
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