Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1046
Peer-review started: June 23, 2020
First decision: July 30, 2020
Revised: August 10, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: November 27, 2020
Processing time: 154 Days and 7.3 Hours
In hepatocellular carcinoma (HCC), detection and treatment prior to growth beyond 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.
To examine the impact of the tumor marker alpha-fetoprotein (AFP) or PIVKA-II in detecting very small HCC nodules (≤ 2 cm in maximum diameter, Barcelona stage 0) in the large number of very small HCC. The difference in the behavior of these tumor markers in HCC development was also examined.
A total of 933 patients with single-nodule HCC were examined. They were subdivided into 394 patients with HCC nodules ≤ 2 cm in maximum diameter and 539 patients whose nodules were > 2 cm. The rates of patients whose AFP and PIVKA-II showed normal values were examined.
The positive ratio of the marker PIVKA-II was significantly different (P < 0.0001) between patients with nodules ≤ 2 cm in diameter and those with nodules > 2 cm, but there was no significant difference in AFP (P = 0.4254). In the patients whose tumor was ≤ 2 cm, 50.5% showed normal levels in AFP and 68.8% showed normal levels in PIVKA-II. In 36.4% of those patients, both AFP and PIVKA-II showed normal levels. The PIVKA-II-positive ratio was markedly increased with an increase in the tumor size. In contrast, the positivity in AFP was increased gradually and slowly.
In the surveillance of very small HCC nodules (≤ 2 cm in diameter, Barcelona clinical stage 0) the tumor markers AFP and PIVKA-II are not so useful.
Core Tip: In hepatocellular carcinoma, detection and treatment prior to nodule growth of 2 cm (Barcelona stage 0) are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites. We surveyed the real impact of the tumor markers alpha-fetoprotein (AFP) or PIVKA-II in detecting very small hepatocellular carcinoma with a large number of cases (≤ 2 cm in diameter 394 cases) and found in AFP that 50.5% and in PIVKA-II that 68.8% showed normal levels. Moreover, 36.4% of the patients showed normal levels in both AFP and PIVKA-II. In the surveillance of very small hepatocellular carcinoma nodules, the tumor markers are not so useful.