Detailed Abstract
[Liver Oral Presentation 1]
[LV OP 1-6] COMBINATION OF PROTEIN INDUCED BY VITAMIN-K ABSENCE AND ALPHA-FETOPROTEIN IMPROVES THE ABILITY TO DETECT HEPATOCELLULAR CANCERS WITH HIGH RISK FOR RECURRENCE ALSO IN A EUROPEAN SETTING
Zoe LARGHI LAUREIRO*1, Samuele IESARI2, Daniele NICOLINI3, Olga CICCARELLI2, Federico MOCCHEGIANI3, Marco VIVARELLI3, Massimo ROSSI1, Quirino LAI1, Jan LERUT2
1General Surgery and Liver Transplant Unit, Sapienza University of Rome, Italy
2Department of Surgery, Université catholique Louvain, Belgium
3Transplant Surgery Unit, Polytechnic University of Marche, Italy
Introduction : The role of Protein induced by vitamin-K absence (PIVKA) has been investigated in Asian countries with the intent to improve the prognostic ability in the specific setting of liver transplantation (LT) and hepatic resection (HR) in patients with hepatocellular cancer (HCC). However, only a limited number of studies has been published in western countries. Moreover, no information exists on the role of PIVKA combined with alpha-fetoprotein (AFP). The aim of the study is to investigate the role of PIVKA as prognosticator of HCC aggressiveness in a European setting.
Methods : 347 HCC patients underwent LT (n=248; 71.5%) or HR (n=99; 28.5%) during the period Jul2010-Nov2019 in three collaborative centres from Belgium and Italy.
Results : Several liver-function, inflammation and tumor markers were tested as predictors of pathological stigmata of poor outcomes. At ROC analysis, MoRAL score was the best predictor of pathological major lesion >5 cm (AUC=0.763; p-value<0.0001) and pathological Milan Criteria-OUT status (AUC=0.703; p-value<0.0001). AFP was the best predictor of poor grading (AUC=0.701; p-value<0.0001), satellitosis (AUC=0.635; p-value=0.001), and microvascular invasion (AUC=0.623; p-value=0.001). AFP*PIVKA was the best predictor of macrovascular invasion (AUC=0.798; p-value=0.001).
Conclusions : The combination of AFP and PIVKA improves the diagnostic ability of recurrence risk factors also in a European setting. Such an ability is particularly evident for the detection of macrovascular invasion. The contemporaneous detection of AFP and PIVKA looks to play a paramount role for a better definition of HCC patients. More studies are required in Europe for implementing the use of PIVKA also in this continent.
Methods : 347 HCC patients underwent LT (n=248; 71.5%) or HR (n=99; 28.5%) during the period Jul2010-Nov2019 in three collaborative centres from Belgium and Italy.
Results : Several liver-function, inflammation and tumor markers were tested as predictors of pathological stigmata of poor outcomes. At ROC analysis, MoRAL score was the best predictor of pathological major lesion >5 cm (AUC=0.763; p-value<0.0001) and pathological Milan Criteria-OUT status (AUC=0.703; p-value<0.0001). AFP was the best predictor of poor grading (AUC=0.701; p-value<0.0001), satellitosis (AUC=0.635; p-value=0.001), and microvascular invasion (AUC=0.623; p-value=0.001). AFP*PIVKA was the best predictor of macrovascular invasion (AUC=0.798; p-value=0.001).
Conclusions : The combination of AFP and PIVKA improves the diagnostic ability of recurrence risk factors also in a European setting. Such an ability is particularly evident for the detection of macrovascular invasion. The contemporaneous detection of AFP and PIVKA looks to play a paramount role for a better definition of HCC patients. More studies are required in Europe for implementing the use of PIVKA also in this continent.
SESSION
Liver Oral Presentation 1
Room A 7/27/2020 12:15 PM - 12:22 PM