الفهرس 
Epidemiology of hepatocellular carcinomaOnly 14 pages are availabe for public view
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Abstract
Introduction: PIVKAII is the acronym for protein induced by vitamin K absence or antagonismII described as a marker for HCC by Liebman et al. (1984). Aim: Estimate serum PIVKAII as a marker for HCC and to compare it versus AFP. Assess its usefulness as a predictor for HCC and as a complementary marker to AFP. Patients & Methodes: 52 CLD patients with liver cirrhosis and HCC attending at MUH during the period from May, 2003 to May, 2004 according to inclusion and exlusion criteria. Results: PIVKAII showed high levels in HCC compared to CLD patients but no correlation existed between AFP and PIVKAII. No correlation found between age PIVKAII or AFP. PIVKAII had negative correlation with albumin and positive correlation with PT and INR in HCC patients with no correlation to any of liver function tests in CLD patients. AFP showed positive correlation only with PT and INR in HCC. PIVKAII level showed positive correlation with each of tumor size, the presence of PV thrombosis, and number of focal hepatic lesions while AFP, did not. Both AFP and PIVKAII showed correlation with CLIP scoring but not with ChildPugh staging. No correlation found between PIVKAII and AFP and the etiology of CLD as HCV, HBV or Schistosomal infection in both HCC and CLD patients. Sensitivity of PIVKAII test was 76.9 %, specificity was 88.4 %, positive predictive value was 86.9 %, negative predictive value was 79.3 %, and overall accuracy was 82.7 %. When AFP and PIVKAII are used together, the sensitivity increased to 84.6 %. Conclusions: PIVKAII is a promising new tumor marker for HCC complementary to AFP in terms of diagnosis. Serum PIVKAII assay every 3 months in cirrhotic patients is important for early detection of HCC better combined with staining for tissue PIVKAII. So, a liver biopsy is usually needed for assessment of tissue PIVKAII.