Abstract
OBJECTIVE: To investigate the expression levels of prothrombin induced by vitamin K absence-II (PIVKA-II) and osteopontin (OPN) in patients with hepatocellular carcinoma (HCC) and cirrhosis, and to evaluate their potential as markers for cirrhosis severity. METHODS: This retrospective study included 84 patients with HCC and cirrhosis treated at the Liver Disease Center of the 904th Hospital from January 2021 to December 2023, forming the cirrhosis group. Fifty healthy individuals undergoing routine physical examinations during the same period comprised the control group. We compared cirrhosis-related indicators and serum levels of PIVKA-II and OPN between the two groups and analyzed the relationships between these biomarkers, liver cancer-related indicators, Child-Pugh grades, tumor size, and their diagnostic value using receiver operating characteristic (ROC) curve analysis. RESULTS: The cirrhosis group showed significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), total bilirubin (TBIL), alpha-fetoprotein (AFP), OPN, and PIVKA-II compared to the control group (all P < 0.05). Conversely, levels of hemoglobin (Hb), white blood cells (WBC), platelets (PLT), and albumin (ALB) were significantly lower (all P < 0.05). Serum levels of OPN, PIVKA-II, AFP, TBIL, PT, and Child-Pugh scores were positively correlated, with correlation coefficients (r values) of 0.678, 0.634, 0.529, 0.617, 0.479, 0.551, 0.620, and 0.054, respectively (all P < 0.05). These markers were negatively correlated with ALB levels, with r values of -0.480 and -0.533 (both P < 0.05). Additionally, higher PIVKA-II and OPN levels were associated with larger tumors (> 3 cm) and more advanced cirrhosis stages (P < 0.05). Over a two-year follow-up, 12 patient deaths were recorded, with deceased patients showing higher levels of PIVKA-II, OPN, and AFP than those in the control group. ROC curve analysis revealed that AFP had a sensitivity of 98.8% and specificity of 82.0% in diagnosing HCC with cirrhosis. OPN achieved a sensitivity of 93.82% and a specificity of 88.0% for diagnosing cirrhosis, while PIVKA-II showed a sensitivity of 98.8% and a specificity of 80.0%. CONCLUSION: Serum levels of PIVKA-II and OPN correlate significantly with HCC presence, cirrhosis severity, Child-Pugh grading, and patient prognosis. Their combined diagnostic use enhances detection rates of HCC with cirrhosis and holds substantial clinical value, recommending their incorporation into clinical practice.