#117 - Diagnostic Performance of Afp, Pivka Ii, Liver Ultrasound, and Their Combined Cutoffs for Hepatocellular Carcinoma Surveillance: a Multicenter Study.
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction and Objectives Hepatocellular carcinoma (HCC) surveillance in at-risk populations with chronic liver disease usually relies on liver ultrasound (US) and alpha-fetoprotein (AFP). Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a complementary biomarker, but optimal cutoff values in Latin American settings remain undefined. To evaluate the diagnostic performance of AFP, PIVKA-II, US, and their combined cutoffs for HCC detection in a multicenter at-risk cohort. Materials and Methods Multicenter cross-sectional study including 300 adults with chronic liver disease at risk for HCC (15 with HCC; 285 without HCC). Serum AFP and PIVKA-II were measured and abdominal US was performed. HCC diagnosis was established by LI-RADS 5 dynamic imaging or histology. ROC curves, Youden index, likelihood ratios, and multivariable logistic regression were applied. Results AFP levels were higher in HCC (p=0.044). AUCs were 0.876 (AFP), 0.862 (PIVKA-II), and 0.873 (AFP+PIVKA-II). AFP>20 ng/mL showed 95% specificity, while the Youden cutoff (>3 ng/mL) improved sensitivity (91%). PIVKA-II>20 ng/mL achieved 100% sensitivity and 53% specificity. Independent predictors of HCC were AFP>20 ng/mL (adjusted OR 30.99; 95% CI 4.58–209.97; p<0.001), PIVKA-II>28.4 ng/mL (OR 42.21; 95% CI 3.04–586.81; p=0.005), male sex (OR 0.09; p=0.026), cirrhosis (OR 26.53; p=0.021), and MASLD etiology (OR 0.06; p=0.016). Conclusions AFP and PIVKA-II improve HCC risk stratification in at-risk populations. Manufacturer cutoffs support confirmatory evaluation, whereas Youden-based thresholds enhance sensitivity for surveillance. Sequential biomarker integration may strengthen early HCC detection.
Source: Annals of Hepatology
Authors: Dayron Páez, Enrique Arús, Anayda Fernández, Mayra Más, Jorge Hernández, Rolando Castillo, Kenia Valenzuela, Marcia Samada, Mirta Infante, Yusimik Román, Ana Arias, Pedro González, Javier Méndez, Marisley Marrero, Magalys Echemendía, Meilis Mesa, Damaris Herrera, Julio Hernández, Gabriela Hernández, Antonio Díaz
Institutions: Hermanos Ameijeiras Hospital, Instituto de Gastroenterología
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7204257705