Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia

Background: Hepatocellular carcinoma(HCC) is the commonest tumour of the liver with multiple aetiologies responsible for cirrhosis which evidently and eventually leads to hepatocellular carcinoma. With drastically increasing incidence since 1990 in Malaysia from 6.1 to 42.8% and with an annual mo...

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Main Author:	Datoo, Adil Anvarali
Format:	Thesis
Language:	English
Published:	2021
Subjects:	RC254-282 Neoplasms Tumors Oncology (including Cancer)
Online Access:	http://eprints.usm.my/57235/1/DR%20ADIL%20ANVARALI%20DATO-24%20pages.pdf
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spelling	my-usm-ep.572352023-03-09T06:45:37Z Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia 2021 Datoo, Adil Anvarali RC254-282 Neoplasms. Tumors. Oncology (including Cancer) Background: Hepatocellular carcinoma(HCC) is the commonest tumour of the liver with multiple aetiologies responsible for cirrhosis which evidently and eventually leads to hepatocellular carcinoma. With drastically increasing incidence since 1990 in Malaysia from 6.1 to 42.8% and with an annual mortality rate of 6.1%, the diagnosis of hepatocellular carcinoma is mainly dependent of imaging and biochemical markers. The commonest imaging modalities used to diagnose hepatocellular carcinoma are magnetic resonance imaging and computed tomography of the liver, while the commonest tumour marker used in conjunction with imaging is alpha-fetoprotein(AFP).In the setting of hepatocellular carcinoma, 30% of the time, the tumour marker alpha-fetoprotein is not elevated which leads to a conundrum during the time of diagnosis. A more robust tumour marker is required and PIVKA-II has shown potential in this regards with a few studies showing that PIVKA-II was superior in both sensitivity and specificity in the initial diagnosis, during follow up post treatment via hepatic artery embolization and hepatic artery infusion and it also shows a better correlation with overall survival in comparison to AFP. The purpose of this study is to evaluate the association between radiological response and PIVKA-II response among patients who undergo interventional radiological treatment, as radiological response is used as a bench mark to either proceed with more interventions or to observe the patients. Methods: A prospective study was conducted at Hospital Universiti Sains Malaysia(USM), Kota Bharu, Kelantan, Malaysia, where 66 patients who underwent interventional radiological treatment for hepatocellular carcinoma had blood investigation for PIVKA-II taken prior to the treatment, 6 weeks post treatment and 3 months post treatment with concurrent computed tomography or magnetic resonance imaging at baseline, 6 weeks post treatment and 3 months post treatment. Of the 66 patients, only 28 patients were available at the end of the 3rd month post intervention, this was due largely to the patients succumbing to their disease and partly due to the pandemic. The radiological response was based on modified response evaluation criteria(mRECIST) into four criteria’s of progressive disease, stable disease, partial response and complete response. PIVKA-II response was classified into either PIVKA-II responders or nonresponders. The association between radiological response and PIVKA response was carried out using Fischer exact test. Results: There was a significant association between radiological response and PIVKA-II response at 6 weeks post interventional radiological treatment with a P value of <0.001 and a Cramer’s V value of 0.71. However at 3 months post treatment, there was no significant association between radiological response and PIVKA-II response with a P value of 0.915 and Cramer’s V value of 0.141. Conclusion: The overall study shows that there was no significant association between post interventional radiological response at 3 months and PIVKA-II response and as of now, tumour marker PIVKA-II in itself cannot be a substitute for radiological imaging. However, it can be used in conjunction with imaging. 2021 Thesis http://eprints.usm.my/57235/ http://eprints.usm.my/57235/1/DR%20ADIL%20ANVARALI%20DATO-24%20pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RC254-282 Neoplasms Tumors Oncology (including Cancer)
spellingShingle	RC254-282 Neoplasms Tumors Oncology (including Cancer) Datoo, Adil Anvarali Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia
description	Background: Hepatocellular carcinoma(HCC) is the commonest tumour of the liver with multiple aetiologies responsible for cirrhosis which evidently and eventually leads to hepatocellular carcinoma. With drastically increasing incidence since 1990 in Malaysia from 6.1 to 42.8% and with an annual mortality rate of 6.1%, the diagnosis of hepatocellular carcinoma is mainly dependent of imaging and biochemical markers. The commonest imaging modalities used to diagnose hepatocellular carcinoma are magnetic resonance imaging and computed tomography of the liver, while the commonest tumour marker used in conjunction with imaging is alpha-fetoprotein(AFP).In the setting of hepatocellular carcinoma, 30% of the time, the tumour marker alpha-fetoprotein is not elevated which leads to a conundrum during the time of diagnosis. A more robust tumour marker is required and PIVKA-II has shown potential in this regards with a few studies showing that PIVKA-II was superior in both sensitivity and specificity in the initial diagnosis, during follow up post treatment via hepatic artery embolization and hepatic artery infusion and it also shows a better correlation with overall survival in comparison to AFP. The purpose of this study is to evaluate the association between radiological response and PIVKA-II response among patients who undergo interventional radiological treatment, as radiological response is used as a bench mark to either proceed with more interventions or to observe the patients. Methods: A prospective study was conducted at Hospital Universiti Sains Malaysia(USM), Kota Bharu, Kelantan, Malaysia, where 66 patients who underwent interventional radiological treatment for hepatocellular carcinoma had blood investigation for PIVKA-II taken prior to the treatment, 6 weeks post treatment and 3 months post treatment with concurrent computed tomography or magnetic resonance imaging at baseline, 6 weeks post treatment and 3 months post treatment. Of the 66 patients, only 28 patients were available at the end of the 3rd month post intervention, this was due largely to the patients succumbing to their disease and partly due to the pandemic. The radiological response was based on modified response evaluation criteria(mRECIST) into four criteria’s of progressive disease, stable disease, partial response and complete response. PIVKA-II response was classified into either PIVKA-II responders or nonresponders. The association between radiological response and PIVKA response was carried out using Fischer exact test. Results: There was a significant association between radiological response and PIVKA-II response at 6 weeks post interventional radiological treatment with a P value of <0.001 and a Cramer’s V value of 0.71. However at 3 months post treatment, there was no significant association between radiological response and PIVKA-II response with a P value of 0.915 and Cramer’s V value of 0.141. Conclusion: The overall study shows that there was no significant association between post interventional radiological response at 3 months and PIVKA-II response and as of now, tumour marker PIVKA-II in itself cannot be a substitute for radiological imaging. However, it can be used in conjunction with imaging.
format	Thesis
qualification_level	Master's degree
author	Datoo, Adil Anvarali
author_facet	Datoo, Adil Anvarali
author_sort	Datoo, Adil Anvarali
title	Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia
title_short	Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia
title_full	Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia
title_fullStr	Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia
title_full_unstemmed	Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia
title_sort	protein induced vitamin k absence(pivka-ii) response in relation to treatment modalities among hepatocellular carcinoma patients at hospital universiti sains malaysia
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2021
url	http://eprints.usm.my/57235/1/DR%20ADIL%20ANVARALI%20DATO-24%20pages.pdf
_version_	1776101193273049088

Protein induced vitamin k absence(PIVKA-II) response in relation to treatment modalities among hepatocellular carcinoma patients at Hospital Universiti Sains Malaysia

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