Diagnostic Performance of AFP, PIVKA-II, and the ASAP Score for Distinguishing Hepatocellular Carcinoma With and Without Portal Vein Tumor Thrombus: A Retrospective Single-Center Study From Pakistan

BACKGROUND: Portal vein tumor thrombus (PVTT) is an important manifestation of advanced hepatocellular carcinoma (HCC). Serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) are established biomarkers associated with tumor burden, vascular invasion, and disease progression in HCC. However, their utility in distinguishing HCC patients with PVTT from those without PVTT remains poorly characterized in the Pakistani population. METHODS: This retrospective single-center study included 100 consecutive, newly diagnosed HCC patients: 46 with PVTT and 54 without PVTT. A separate group of 55 cancer-free controls was included solely for a secondary exploratory HCC-versus-control analysis. Diagnostic performance of AFP, PIVKA-II, and the Age-Sex-AFP-PIVKA-II (ASAP) score was evaluated using two-sided Mann-Whitney U tests, receiver operating characteristic (ROC) curve analysis, Youden index cutoffs, Spearman correlation, and multivariable logistic regression. ASAP values were calculated consistently from the raw variables before analysis. RESULTS: AFP and PIVKA-II were significantly higher in patients with PVTT than those without PVTT (AFP: p