The application of abnormal prothrombin in predicting the efficacy of TACE in the treatment of hepatocellular carcinoma

Objective: To investigate the expression of abnormal prothrombin (vitamin K absence or antagonist-II, PIVKA-II) in serum of patients with hepatocellular carcinoma (HCC) receiving transcatheter arterial chemoembolization (TACE), and to discuss its clinical significance. Methods: A total of 170 HCC patients, who received TACE during the period from January 2013 to January 2016, were enrolled in this study. The serum sampling were collected before TACE and one month after TACE. The expression levels of PIVKA-II and alpha fetoprotein (AFP) in serum were tested. According to the response evaluation criteria in solid tumors (RECIST), the antitumor response of TACE was graded as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). The serum expression levels of PIVKA-II and AFP measured at one month after TACE were compared with pre-TACE basic values. Taking the tumor size measured on one-month follow-up abdominal contrast-enhanced MRI as standard, the relationship between tumor size and HCC response to TACE was analyzed. Results: No significant correlation existed between the post-TACE changes in AFP level and the therapeutic response. The post-TACE decreased degree of PIVKA-II was positively correlated with therapeutic response (CR/PR). Combination consideration of PIVKA-II and AFP bore more close relationship with therapeutic response, and there was no significant correlation between PIVKA-II and AFP. Conclusion: The post-TACE decrease in serum PIVKA-II is a useful index in predicting the curative effect of TACE for HCC as well as in predicting the prognosis of patient, and the predicting result will be more accurate if AFP level is simultaneously taken into consideration. (authors)