Prognostic Significance of Combined α-Fetoprotein and PIVKA-II for Hepatocellular Carcinoma After Hepatectomy.

PURPOSE: Hepatocellular carcinoma (HCC) exhibits notable prognostic heterogeneity. While AFP is a routine HCC prognostic biomarker, its limited detection rate restricts standalone use. This study aimed to evaluate the prognostic value of combined preoperative AFP and PIVKA-II for postoperative outcomes in HCC patients undergoing hepatectomy.

PATIENTS AND

METHODS

A total of 553 patients were retrospectively enrolled and stratified into double-positive (DP), single-positive (SP), and double-negative (N) groups based on preoperative AFP (>400 ng/mL) and PIVKA-II (>40 ng/mL) levels. Kaplan-Meier survival curves assessed overall survival (OS) and recurrence-free survival (RFS). Univariate and multivariate Cox models identified independent clinicopathological survival predictors.

RESULTS

The N group demonstrated significantly better OS and RFS rates at 1 and 2 years than the SP group, while the DP group exhibited the poorest outcomes. Multivariate Cox regression analysis identified tumor size >5 cm and PIVKA-II >40 ng/mL as independent risk factors for both OS and RFS. Moreover, advanced age (>60 years) and multiple tumors (≥2) were independently associated with poorer OS, whereas tumor size ≥5 cm, BCLC stage C, and AFP >400 ng/mL were independent predictors of reduced RFS. The combined AFP/PIVKA-II stratification exhibited good prognostic discriminative ability for postoperative survival, with a C-index of 0.728 (95% CI: 0.650-0.806), but single biomarkers maintained independent prognostic power.

CONCLUSION

Based on the independent prognostic value of individual biomarkers, combined evaluation of AFP and PIVKA-II provides a supplementary tool to refine postoperative risk stratification for HCC patients after hepatectomy.