Abstract: Objective The aim of this study was to investigate the clinical implication of serum alpha-fetoprotein (AFP), alpha-fetoprotein-L-3 ratio (AFP-L3%) and protein induced by vitamin K antagonist-II (PIVKA-II) in early diagnosing and predicting prognosis of patients with primary liver cancer(PLC) . Methods A total of 87 patients with PLC, 79 patients with hepatitis B cirrhosis, 73 patients with chronic hepatitis B and 65 healthy persons were enrolled in our hospital between January 2016 and December 2018. All PLC patients underwent transcatheter arterial chemoembolization (TACE) and were followed-up for 3 years. Serum AFP and PIVKA-II levels were detected by chemiluminescence immunoassay, and serum AFP-L3 level was assayed by immumofluorescence. The independent risk factors of impacting 3-year survival in patients with PLC were analyzed by Logistic regression analysis, and the prognostic value of serum AFP, AFP-L3% and PIVKA-II levels was evaluated by the area under the receiver operating characteristic (ROC) curves (AUC). Results Serum AFP, AFP-L3% and PIVKA-II levels in patients with PLC were 402.5±95.3)μg/L, (12.9±3.1) and (824.5±82.1) mAU/mL, significantly higher than [(17.9±2.6)μg/L, (8.6±1.2) and (30.4±3.2)mAU/mL, P＜0.05] in patients with liver cirrhosis or [(20.3±6.4)μg/L,(5.4±0.9) and(29.8±3.0)mAU/mL, P＜0.05]in patients with CHB or [(2.2±0.1)μg/L, (2.7±0.4) and (26.3±3.4)mAU/mL, P＜0.05] in healthy individuals; serum AFP, AFP-L3% and PIVKA-II levels in 52 dead patients with PLC one month after TACE were (447.1±71.2)μg/L, (14.1±2.2) and (883.9±50.8) mAU/mL, much higher than [(336.2±58.4)μg/L, (11.0±1.8) and (736.2±37.0)mAU/mL, respectively, P＜0.05] in 35 survivals; the univariate analysis showed that TNM staging, Child class, extrahepatic metastasis, serum AFP, AFP-L3% and PIVKA-II levels were all influencing prognosis of patients with PLC (P<0.05), and the multivariate Logistic regression analysis showed that TNM staging III-IV, Child class C, extrahepatic metastasis, serum AFP ≥410.5μg/L, AFP-L3% ≥12.1 and PIVKA-II≥807.2 mAU/mL were all independent risk factors for poor prognosis of patients with PLC(P<0.05); the ROC analysis showed that the AUC was 0.908 when combination of serum AFP, AFP-L3% and PIVKA-II level detection in predicting the 3-year survival of patients with PLC, greatly superior to any parameter alone (the AUC were 0.763, 0.830 or 0.792, respectively, P<0.05). Conclusion The combination detection of serum AFP, AFP-L3% and PIVKA-II levels could help diagnose and early predict prognosis of patients with PLC after TACE treatment.

Key words: Hepatoma, Transcatheter arterial chemoembolization, Alpha-fetoprotein, Alpha-fetoprotein-L-3 ratio, Protein induced by vitamin K antagonist-II, Diagnosis, Prognosis