CLINICAL-EVALUATION OF PLASMA DES-GAMMA-CARBOXY PROTHROMBIN AS A MARKER PROTEIN OF HEPATOCELLULAR-CARCINOMA IN PATIENTS WITH TUMORS OF VARIOUS SIZES

被引:73
作者
KASAHARA, A
HAYASHI, N
FUSAMOTO, H
KAWADA, Y
IMAI, Y
YAMAMOTO, H
HAYASHI, E
OGIHARA, T
KAMADA, T
机构
[1] OSAKA UNIV,SCH MED,DEPT MED 1,OSAKA 553,JAPAN
[2] OSAKA UNIV,SCH MED,DEPT MED 2,OSAKA 553,JAPAN
[3] OSAKA UNIV,SCH MED,DEPT MED 3,OSAKA 553,JAPAN
[4] OSAKA UNIV,SCH MED,DEPT GERIATR MED,OSAKA 553,JAPAN
关键词
DES-GAMMA-CARBOXYPROTHROMBIN; PIVKA-II; HEPATOCELLULAR CARCINOMA; ALPHA-FETOPROTEIN;
D O I
10.1007/BF01299891
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
We measured des-gamma-carboxyprothrombin (DCP) (prothrombin induced by vitamin K absence or antagonist-II, abbreviated as PIVKA-II) by a newly developed enzyme immunoassay using an anti-DCP monoclonal antibody in 665 human subjects, of which 112 were patients with hepatocellular carcinoma (HCC). PIVKA-II was elevated to more than 0.1 AU/ml in 54 of the 112 patients (48.2%) with HCC, while it was positive only in 7.1% of those with liver cirrhosis and 3.1% of those with chronic hepatitis. Three patients with elevated PIVKA-II greater than 0.1 AU/ml who had been diagnosed as having liver cirrhosis by ultrasonography and computed tomography at the start of this study developed a diffuse type of HCC three or six months later, which was detected by angiography. No obvious correlation was observed between plasma PIVKA-II concentration and serum cr-fetoprotein (AFP) level in HCC patients. Of the 112 HCC patients, 40.2% showed an increase in AFP to above 200 ng/ml. In the remaining patients, 32.8% had a PIVKA-II concentration greater than 0.1 AU/ml. In these patients with a negative or low serum AFP concentration, PIVKA-II proved to be a valuable tumor marker for laboratory diagnosis of HCC. Among them, 59.8% tested positive for PIVKA-II and/or AFP. Thus, combination assay with PIVKA-II and AFP seems useful for increasing the accuracy of laboratory diagnosis of HCC. None of patients with a solitary tumor smaller than 2 cm had elevated PIVKA-II. In patients with larger-sized and multiple HCC, positive results of elevated PIVKA-II were more frequent than those of increased AFP. Thus, the determination of PIVKA-II may be more useful than AFP assay in patients with larger-sized and multiple tumors. The levels of plasma PIVKA-II concentration were higher in patients with larger-sized and multiple tumors than in those with smaller ones. In 20 patients, PIVKA-II decreased significantly after transcatheter arterial embolization (TAE) therapy, and in eight of these 20 patients it normalized after TAE. In conclusion, plasma PIVKA-II be used as a valuable marker for the diagnosis and screening of HCC, especially in patients with negative or low AFP and in those with larger-sized and multiple tumors. However, its usefulness for mass screening of small HCC is limited.
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页码:2170 / 2176
页数:7
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