# Pilot Study of PIVKA-II in the Prognostic Assessment of Hepatocellular Carcinoma in Chronic Viral Hepatitis: Comparative Findings from HBV and HCV Cohorts from a Single Center in Serbia

## TL;DR

This study shows that PIVKA-II and AFP are useful for predicting liver cancer in patients with chronic hepatitis B and C, with their combination offering better accuracy.

## Contribution

The study introduces the combined use of PIVKA-II and AFP for improved HCC risk prediction in HBV and HCV patients.

## Key findings

- PIVKA-II and AFP independently predicted HCC development in both HBV and HCV cohorts.
- The combined biomarker score (AFP × PIVKA-II) showed superior predictive accuracy for HCC risk.
- Chronic alcohol abuse, cirrhosis, and liver stiffness were additional independent predictors of HCC.

## Abstract

Background: Hepatocellular carcinoma (HCC) frequently develops in patients with chronic hepatitis B and C. Early detection is critical, but current methods, including ultrasound and AFP, have suboptimal accuracy. Objectives: This study aimed to evaluate the predictive performance of protein induced by vitamin K absence or antagonist-II (PIVKA-II) and alpha-fetoprotein (AFP) testing, alone and in combination, for HCC development. Methods: A retrospective cohort study at a single university center included 242 CHB and 181 CHC patients. Data on demographics, clinical status, laboratory parameters, and imaging were collected, with fibrosis and steatosis assessed by FibroScan®. Serum AFP and PIVKA-II were measured, but measurements of PIVKA-II in patients receiving vitamin K antagonists were excluded from the analysis. HCC diagnosis and staging followed clinical guidelines. Cox regression and ROC analyses identified independent predictors and evaluated biomarker accuracy for HCC detection. Results: HCC incidence was comparable between cohorts (5.0% in CHB vs. 5.5% in CHC). Both AFP and PIVKA-II independently predicted HCC development in multivariate models adjusted for age and sex. The combined biomarker score (AFP × PIVKA-II) showed superior predictive accuracy with hazard ratios of 1.38 (CHB) and 1.36 (CHC). ROC analyses demonstrated high discriminative ability for PIVKA-II (AUC ~0.81) and AFP (AUC ~0.83) in both cohorts. Additional independent predictors were chronic alcohol abuse, cirrhosis, and higher liver stiffness measurements. Specific viral factors such as HBeAg positivity and HCV subgenotype 1b were also associated with increased HCC risk. Conclusions: AFP and PIVKA-II are independent, valuable biomarkers for HCC risk in chronic hepatitis B and C. Combined use improves early detection, aiding timely treatment. These results support adding PIVKA-II to AFP in surveillance, but larger studies are needed to confirm the findings and refine cut-off values.