Sains Malaysiana 50(2)(2021): 475-480

http://dx.doi.org/10.17576/jsm-2021-5002-18

Association between Prothrombin Induced by Vitamin K Absence-II (PIVKA- II) and Barcelona Clinic Liver Cancer (BCLC) Stage, Tumor Size, Portal Venous Thrombosis in Hepatocellular Carcinoma Patients

(Perkaitan antara Protrombin yang Dipengaruhi oleh Ketiadaan Vitamin K II (PIVKA-II)
dan Tahap Kanser Hati Klinik Barcelona (BCLC), Saiz Tumor, Trombosis Vena Portal pada Pesakit Karsinoma Hepatosel)

DARMADI DARMADI¹* & RISKA HABRIEL RUSLIE²

¹Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, dr. Mansyur 5, Medan, Indonesia

²Faculty of Medicine, Universitas Prima Indonesia, Ayahanda 68 A, Medan, Indonesia

Received: 5 April 2020/Accepted: 5 August 2020

ABSTRACT

Hepatocellular carcinoma is one of the major cancer problems in the world because of the low early screening awareness in patients. Serum alpha-fetoprotein is not adequate as a single screening tool, especially for small HCCs, thus, prothrombin induced by vitamin K absence-II (PIVKA-II) can help in detecting small HCCs. Barcelona Clinic Liver Cancer (BCLC) stage remains to be the preferred HCC classification because it can predict the outcome and help in choosing available treatment options according to stages. This study aims to investigate the association between PIVKA-II levels with BCLC stage, tumor size, portal venous thrombosis in HCC patients. We enrolled patients with newly diagnosed HCC at the Adam Malik General Hospital, Medan, Indonesia from January to December 2018. Patients with HCC were classified according to BCLC stages, findings of portal venous thrombosis and tumor size from triphasic CT scan were noted, and serum PIVKA-II levels were measured. Sixty patients were included in this study. There were significant differences in serum PIVKA-II levels with different stages of BCLC (p < 0.001). Significantly higher serum PIVKA-II levels were detected in patients with portal venous thrombosis (p < 0.001) and larger size tumors (p < 0.003). Our study shows that serum PIVKA-II levels can help to diagnose, differentiate between stages of BCLC, and determine the prognosis in patients with HCC.

Keywords: Hepatocellular carcinoma; hepatoma; liver cell carcinoma; tumor biomarkers

ABSTRAK

Karsinoma hepatosel adalah salah satu masalah kanser utama di dunia kerana kesedaran awal yang rendah dalam kalangan pesakit. Serum alfa-fetoprotein tidak mencukupi sebagai alat pemeriksaan tunggal, terutamanya untuk HCCs kecil, oleh itu protrombin yang disebabkan oleh ketiadaan vitamin K II (PIVKA-II) dapat membantu dalam mengesan HCCs kecil. Tahap Kanser Hati Klinik Barcelona (BCLC) tetap menjadi pilihan dalam pengelasan HCC kerana dapat meramalkan hasil dan membantu dalam memilih pilihan rawatan yang tersedia mengikut tahap. Kajian ini bertujuan untuk mengkaji hubungan antara tahap PIVKA-II dengan peringkat BCLC, saiz tumor, trombosis vena portal pada pesakit HCC. Kami mendaftarkan pesakit dengan HCC yang baru didiagnosis di Hospital Besar Adam Malik, Medan, Indonesia sepanjang tempoh Januari hingga Disember 2018. Pesakit dengan HCC dikelaskan mengikut tahap BCLC, penemuan trombosis vena portal dan saiz tumor daripada imbasan CT triphasic dicatat dan paras serum PIVKA-II dihitung. Enam puluh pesakit dimasukkan ke dalam kajian ini. Terdapat perbezaan yang signifikan antara paras serum PIVKA-II dengan peringkat BCLC yang berlainan (p < 0.001). Tahap serum PIVKA-II yang lebih tinggi dikesan pada pesakit dengan trombosis vena portal (p < 0.001) dan tumor saiz yang lebih besar (p < 0.003). Kajian kami menunjukkan bahawa tahap serum PIVKA-II boleh membantu untuk mendiagnosis, membezakan antara peringkat BCLC dan menentukan prognosis pada pesakit dengan HCC.

Kata kunci: Penanda biologi tumor; hepatoma; karsinoma hepatosel; karsinoma sel hati

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*Corresponding author; email: ign.darmadi@yahoo.com