The prognostic value of protein induced by vitamin K absence or antagonist-II in hepatocellular carcinoma patients undergoing surgical resection

OBJECTIVE: The main objective of this study is to investigate the prognostic value of serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) in predicting postoperative outcomes for hepatocellular carcinoma (HCC) patients after surgical resection. METHODS: Serum PIVKA‑II levels were compared between early‑stage (stage I+II) and advanced‑stage (stage III+IV) HCC patients. Correlations between PIVKA‑II and clinicopathological features were examined. Kaplan‑Meier curves were plotted to assess overall survival (OS) and recurrence‑free survival (RFS) by PIVKA‑II levels. Receiver operating characteristic (ROC) analysis compared the predictive performance of PIVKA‑II and α ‑fetoprotein (AFP), with DeLong 's test evaluating differences in area under the curve. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors for postoperative survival and recurrence. RESULTS: Serum PIVKA‑II levels were significantly elevated in HCC patients compared with controls ( P < 0.01), and were higher in advanced‑stage than early‑stage HCC ( P < 0.01). PIVKA‑II correlated significantly with tumor diameter, tumor node metastasis classification, lymph node infiltration, distant metastasis, differentiation, and complication incidence (all P < 0.05). Patients with high PIVKA‑II (≥100 mAU/ml) had shorter median OS and RFS than those with low levels (