Introduction : The prognostic value of PIVKA-II has been insufficiently elucidated. This study is aimed to determine the prognostic value of preoperative serum PIVKA-II after hepatectomy for hepatitis b related HCC.

Methods : The nationwide multicenter database of the Korean Liver Cancer Association was reviewed. Patients with hepatitis b related HCC who underwent liver resection as a first treatment after initial diagnosis between 2008 and 2014 were selected. Comparative analysis between low versus high PIVKA-II was performed. Survival outcomes of propensity score-matched groups were compared. Kaplan–Meier and multivariable analyses were performed to identify risk factors for disease-specific survival. Univariable and multivariable Cox proportional hazards regression were used.

Results : Among 6,770 randomly selected patients with hepatitis b related HCC, 987 patients were included. The disease-specific 5-year survival rate was 84.6% in patients with PIVKA-II of 106.5mAU/mL or less compared with 76.3% for those with a level exceeding 106.5mAU/mL (p=0.041). After propensity score matching, the two groups were well balanced (n=263, each). In univariable analysis, high PIVKA-II (>106.5mAU/mL) was a significant predictor for worse survival (hazard ratio (HR), 1.527; p=0.047). In multivariable analysis, lymph node positivity (HR, 6.123; p=0.023), hyponatremia (<135mEq/L) (HR, 4.187; p=0.002), tumor size ≥5.0cm (HR, 3.399; p<0.001), preoperative ascites (HR, 3.874; p=0.001), microvascular invasion (HR, 2.639; p=0.001), thrombocytopenia(<100x103/µL) (HR, 2.620; p=0.001), and multiple HCC (HR, 2.068; p=0.007) were independent predictors for worse disease-specific survival, but not preoperative high PIVKA-II.

Conclusions : Preoperative high PIVKA-II is significantly associated with worse disease-specific survival after hepatectomy for hepatitis b related HCC, nonetheless, not a strong prognostic factor.