Letter to the Editor: Toward biology-driven transplant oncology: The role of PIVKA-II in alpha-fetoprotein-normal hepatocellular carcinoma

doi:10.4251/wjgo.118170

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Aug 15, 2026; 18(8): 118170
Published online Aug 15, 2026. doi: 10.4251/wjgo.118170

Letter to the Editor: Toward biology-driven transplant oncology: The role of PIVKA-II in alpha-fetoprotein-normal hepatocellular carcinoma

Sagar Raut, Pradeep Naik E

Sagar Raut, Department of Radiotherapy and Oncology, PGIMER Satellite Centre, Sangrur 148001, India

Pradeep Naik E, Department of Radiation Oncology, All India Institute of Medical Sciences, Nagpur 441108, Mahārāshtra, India

Author contributions: Raut S and Naik EP designed the report, conducted the literature review, analyzed the data, and wrote the paper; all authors read and approved the final version of the manuscript.

AI contribution statement: ChatGPT was used for language polishing and writing assistance.

Conflict-of-interest statement: All authors have no conflicts of interest related to the manuscript.

Corresponding author: Sagar Raut, MD, Assistant Professor, Department of Radiotherapy and Oncology, PGIMER Satellite Centre, Patiala Road, Sangrur 148001, India. snraut161@gmail.com

Received: December 26, 2025
Revised: January 28, 2026
Accepted: February 4, 2026
Published online: August 15, 2026
Processing time: 220 Days and 10.5 Hours

Core Tip

Core Tip: Hepatocellular carcinoma with normal alpha-fetoprotein (AFP) levels is a frequently missed when transplantation selection relies heavily on morphological criteria and AFP levels. Emerging evidence identified PIVKA-II as a robust marker of aggressive tumor biology in this subgroup. PIVKA-II successfully categorized high-risk disease despite favorable imaging and normal AFP levels. Integration of PIVKA-II with existing selection frameworks will enable a shift toward biology-driven transplant oncology and reduce post-transplant recurrence.