Background: As a promising biomarker of hepatocellular carcinoma(HCC), protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) has been studied extensively. However, its diagnostic capability varies across HCC...Background: As a promising biomarker of hepatocellular carcinoma(HCC), protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) has been studied extensively. However, its diagnostic capability varies across HCC studies. This study aimed to compare the performance of PIVKA-Ⅱ with alpha-fetoprotein(AFP) in the diagnosis of HCC. Data sources: A systematic literature search was conducted to identify the studies from MEDLINE, Embase and Cochrane Library Databases, which were published up to December 20, 2017 to compare the diagnostic capability of PIVKA-Ⅱ and AFP for HCC. The data were pooled using random effects model. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curve(ROC) was employed to evaluate the diagnostic accuracy of each marker. Results: Thirty-one studies were included. The pooled sensitivity(95% CI) of PIVKA-Ⅱ and AFP was 0.66(0.65–0.68) and 0.66(0.65–0.67), respectively in diagnosis of HCC; and the corresponding pooled specificity(95% CI) was 0.89(0.88–0.90) and 0.84(0.83–0.85), respectively. The area under the ROC curve(AUC) of PIVKA-Ⅱ and AFP was 0.856(0.817–0.895) and 0.770(0.728–0.811), respectively. Subgroup analysis showed that PIVKA-Ⅱ was superior to AFP in terms of the AUC for both small HCC( < 3 cm) [0.863(0.825–0.901) vs 0.717(0.658–0.776)] and large HCC( ≥ 3 cm) [0.854(0.811–0.897) vs 0.729(0.682–0.776)]; for American [0.926(0.897–0.955) vs 0.698(0.594–0.662)], European [0.772(0.743–0.801) vs 0.628(0.594–0.662)], Asian [0.838(0.812–0.864) vs 0.785(0.764–0.806)] and African [0.812(0.794–0.840) vs 0.721(0.675–0.767)] HCC patients; and for HBV-related [0.909(0.866–0.951) vs 0.714(0.673–0.755)] and mixed-etiology [0.847(0.821–0.873) vs 0.794(0.772–0.816)] HCC. Conclusion: This meta-analysis indicates that PIVKA-Ⅱ is better than AFP in terms of the accuracy for diagnosing HCC, regardless of tumor size, patient ethnic group, or HCC etiology.展开更多
Background:Family history is a risk factor for the development of hepatocellular carcinoma(HCC).The aim of the current study was to investigate the association between family history of HCC and long-term oncologic pro...Background:Family history is a risk factor for the development of hepatocellular carcinoma(HCC).The aim of the current study was to investigate the association between family history of HCC and long-term oncologic prognosis among patients undergoing curative liver resection for hepatitis B virus(HBV)-related HCC.Methods:Patients who underwent curative liver resection of HBV-related HCC between 2003 and 2013 were consecutively enrolled.Family history was defined as a self-reported history of HCC in a first-degree relative.Propensity score matching(PSM)and multivariable Cox-regression analyses were performed to compare overall survival(OS)and recurrence-free survival(RFS)among patients with and without a family history.Results:Among 1,112 patients,183(16.5%)patients had a family history of HCC.Using PSM,179 pairs of patients with and without a family history were created that had no differences in the baseline characteristics and operative variables.On matched analysis,family history was associated with decreased OS and RFS after curative-intent resection of HBV-related HCC in the propensity matching cohort(P=0.042 and 0.006,respectively).On multivariable Cox-regression analyses,a family history of HCC was associated with decreased OS(HR:1.574;95%CI:1.171–2.116;P=0.003)and RFS(HR:1.534;95%CI:1.176–2.002;P=0.002)after adjusting for other prognostic risk factors.Conclusions:Family history was associated with decreased OS and RFS rates among patients undergoing curative liver resection of HBV-related HCC.展开更多
基金supported in part by the National Natural Sci-ence Foundation of China(81472284 and 81672699)Shanghai Pujiang Program(16PJD004)
文摘Background: As a promising biomarker of hepatocellular carcinoma(HCC), protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) has been studied extensively. However, its diagnostic capability varies across HCC studies. This study aimed to compare the performance of PIVKA-Ⅱ with alpha-fetoprotein(AFP) in the diagnosis of HCC. Data sources: A systematic literature search was conducted to identify the studies from MEDLINE, Embase and Cochrane Library Databases, which were published up to December 20, 2017 to compare the diagnostic capability of PIVKA-Ⅱ and AFP for HCC. The data were pooled using random effects model. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curve(ROC) was employed to evaluate the diagnostic accuracy of each marker. Results: Thirty-one studies were included. The pooled sensitivity(95% CI) of PIVKA-Ⅱ and AFP was 0.66(0.65–0.68) and 0.66(0.65–0.67), respectively in diagnosis of HCC; and the corresponding pooled specificity(95% CI) was 0.89(0.88–0.90) and 0.84(0.83–0.85), respectively. The area under the ROC curve(AUC) of PIVKA-Ⅱ and AFP was 0.856(0.817–0.895) and 0.770(0.728–0.811), respectively. Subgroup analysis showed that PIVKA-Ⅱ was superior to AFP in terms of the AUC for both small HCC( < 3 cm) [0.863(0.825–0.901) vs 0.717(0.658–0.776)] and large HCC( ≥ 3 cm) [0.854(0.811–0.897) vs 0.729(0.682–0.776)]; for American [0.926(0.897–0.955) vs 0.698(0.594–0.662)], European [0.772(0.743–0.801) vs 0.628(0.594–0.662)], Asian [0.838(0.812–0.864) vs 0.785(0.764–0.806)] and African [0.812(0.794–0.840) vs 0.721(0.675–0.767)] HCC patients; and for HBV-related [0.909(0.866–0.951) vs 0.714(0.673–0.755)] and mixed-etiology [0.847(0.821–0.873) vs 0.794(0.772–0.816)] HCC. Conclusion: This meta-analysis indicates that PIVKA-Ⅱ is better than AFP in terms of the accuracy for diagnosing HCC, regardless of tumor size, patient ethnic group, or HCC etiology.
基金This work was supported in part by the National Natural Science Foundation of China(81472284 and 81672699 for T Yang).
文摘Background:Family history is a risk factor for the development of hepatocellular carcinoma(HCC).The aim of the current study was to investigate the association between family history of HCC and long-term oncologic prognosis among patients undergoing curative liver resection for hepatitis B virus(HBV)-related HCC.Methods:Patients who underwent curative liver resection of HBV-related HCC between 2003 and 2013 were consecutively enrolled.Family history was defined as a self-reported history of HCC in a first-degree relative.Propensity score matching(PSM)and multivariable Cox-regression analyses were performed to compare overall survival(OS)and recurrence-free survival(RFS)among patients with and without a family history.Results:Among 1,112 patients,183(16.5%)patients had a family history of HCC.Using PSM,179 pairs of patients with and without a family history were created that had no differences in the baseline characteristics and operative variables.On matched analysis,family history was associated with decreased OS and RFS after curative-intent resection of HBV-related HCC in the propensity matching cohort(P=0.042 and 0.006,respectively).On multivariable Cox-regression analyses,a family history of HCC was associated with decreased OS(HR:1.574;95%CI:1.171–2.116;P=0.003)and RFS(HR:1.534;95%CI:1.176–2.002;P=0.002)after adjusting for other prognostic risk factors.Conclusions:Family history was associated with decreased OS and RFS rates among patients undergoing curative liver resection of HBV-related HCC.
