Datoo, Adil Anvarali
(2021)
Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Hepatocellular carcinoma(HCC) is the commonest tumour of the
liver with multiple aetiologies responsible for cirrhosis which evidently and
eventually leads to hepatocellular carcinoma. With drastically increasing
incidence since 1990 in Malaysia from 6.1 to 42.8% and with an annual mortality
rate of 6.1%, the diagnosis of hepatocellular carcinoma is mainly dependent of
imaging and biochemical markers. The commonest imaging modalities used to
diagnose hepatocellular carcinoma are magnetic resonance imaging and
computed tomography of the liver, while the commonest tumour marker used in
conjunction with imaging is alpha-fetoprotein(AFP).In the setting of
hepatocellular carcinoma, 30% of the time, the tumour marker alpha-fetoprotein
is not elevated which leads to a conundrum during the time of diagnosis. A more
robust tumour marker is required and PIVKA-II has shown potential in this
regards with a few studies showing that PIVKA-II was superior in both
sensitivity and specificity in the initial diagnosis, during follow up post treatment
via hepatic artery embolization and hepatic artery infusion and it also shows a better correlation with overall survival in comparison to AFP. The purpose of
this study is to evaluate the association between radiological response and
PIVKA-II response among patients who undergo interventional radiological
treatment, as radiological response is used as a bench mark to either proceed with
more interventions or to observe the patients.
Methods: A prospective study was conducted at Hospital Universiti Sains
Malaysia(USM), Kota Bharu, Kelantan, Malaysia, where 66 patients who
underwent interventional radiological treatment for hepatocellular carcinoma
had blood investigation for PIVKA-II taken prior to the treatment, 6 weeks post
treatment and 3 months post treatment with concurrent computed tomography or
magnetic resonance imaging at baseline, 6 weeks post treatment and 3 months
post treatment. Of the 66 patients, only 28 patients were available at the end of
the 3rd month post intervention, this was due largely to the patients succumbing
to their disease and partly due to the pandemic. The radiological response was
based on modified response evaluation criteria(mRECIST) into four criteria’s of
progressive disease, stable disease, partial response and complete response.
PIVKA-II response was classified into either PIVKA-II responders or nonresponders.
The association between radiological response and PIVKA response
was carried out using Fischer exact test.
Results: There was a significant association between radiological response and
PIVKA-II response at 6 weeks post interventional radiological treatment with a
P value of <0.001 and a Cramer’s V value of 0.71. However at 3 months post treatment, there was no significant association between radiological response
and PIVKA-II response with a P value of 0.915 and Cramer’s V value of 0.141.
Conclusion: The overall study shows that there was no significant association
between post interventional radiological response at 3 months and PIVKA-II
response and as of now, tumour marker PIVKA-II in itself cannot be a substitute
for radiological imaging. However, it can be used in conjunction with imaging.
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