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PubMed1990

The prognostic significance of tumor ploidy and pathology in adenocarcinoma of the esophagogastric junction.

Tumor DNA content has been advocated to be an important prognostic indicator in human malignancies. Paraffin-embedded specimens of 75 resected adenocarcinomas (AC) of the esophagogastric junction were studied by flow cytometric DNA analysis to determine whether tumor ploidy was a significant prognostic variable independent of stage and histologic grade of the tumor. Eighty-one percent of the tumors were aneuploid. More patients with aneuploid tumors had lymph node metastases than patients with diploid tumors (P = 0.007). Patients with aneuploid tumors had poorer 18-month disease-free and overall survival than patients with diploid tumors. Cox regression analysis demonstrated that the most important prognostic variables for predicting overall survival were lymph node status, depth of wall invasion, and tumor differentiation. Tumor ploidy was not an independent prognostic variable in predicting recurrent disease or death from AC of the esophagogastric junction. Tumor DNA content is valuable, however, as a marker for patients at increased risk of lymph node metastases, early recurrence, and poorer survival.

Adenocarcinoma↗

PubMed1990

Is DNA ploidy an independent prognostic indicator in infiltrative node-negative breast adenocarcinoma?

To evaluate DNA content as an independent, long-term prognostic indicator in infiltrative, node-negative adenocarcinoma of the breast, flow cytometric DNA analyses were performed retrospectively in 165 patients. The exclusive use of paraffin-embedded tissue permitted the study of patients for whom 3 to 15 years' follow-up was available. Other investigators have shown a relationship between DNA nuclear content and well-known prognostic indicators of breast carcinoma, such as estrogen receptors, age, menopausal status, and stage of tumor. However, very few of these studies were based on patients with long-term clinical follow-up and investigated the independent prognostic value of DNA nuclear content. The frequency of aneuploidy in the patients in this study was 57%, with DNA indices ranging from 0.73 to 2.59. Survival in patients with localized breast carcinoma with DNA aneuploid tumors was 84.1% at 5 years and 75.5% at 10 years. Those with diploid tumors showed survival of 87.8% at 5 years and 73.4% at 10 years. These data show no independent prognostic value for DNA nuclear content. The relationship between DNA content, tumor histologic type, and age was also investigated. High-grade tumors were more often aneuploid. There was no association between DNA content and age. Of 165 patients, information regarding estrogen receptor status was available in only 77; 45% of those with aneuploid tumors and 35% with diploid tumors were estrogen receptor-negative. This difference was not significant. The authors conclude that simple determination of DNA ploidy fails to indicate prognosis for infiltrative, node-negative breast carcinoma.

Adenocarcinoma↗

PubMed1990

Clinical prognostic factors in patients with posterior uveal malignant melanoma.

The authors evaluated the prognostic value of clinically assessed variables for predicting length of survival until death from metastatic disease in 237 patient with a primary choroidal or ciliary body melanoma. Using multivariate Cox proportional hazards modeling, the authors identified the largest linear basal tumor diameter (mm), estimated by indirect ophthalmoscopy and fundus drawing, the location of the anterior margin of the tumor relative to the ocular equator and ora serrata, and the age of the patient at the time of treatment as the best combination of the clinically assessed variables for predicting survival. For each patient in this group, the authors computed a prognostic index based on the best multivariate Cox model. They showed that patients with low, intermediate, and high values of prognostic index had low, intermediate, and high melanoma-related mortality rates, respectively, during the first 5 to 8 posttreatment years. These results suggest that: (1) clinically assessed variables evaluated according to a standardized protocol are useful for predicting the survival of treated patients with posterior uveal melanoma and (2) ophthalmologists who assess potential clinical prognostic variables consistently may identify subgroups of patients with comparable mortality risk on the basis of noninvasive testing.

Analysis of Variance↗

PubMed1992

C-erbB-2 oncoprotein expression versus internal mammary lymph node metastases as additional prognostic factors in patients with axillary lymph node-positive breast cancer.

The relationship was assessed between c-erbB-2 oncoprotein expression and other prognostic factors in breast cancer, such as axillary and internal mammary node metastases. The value of these indicators was analyzed in estimating prognosis, especially in patients with axillary node-positive breast cancer. These results showed that c-erbB-2 is significantly related to clinical stage and axillary node metastases. A univariate study revealed that disease-free and overall survival were correlated significantly with clinical stage, tumor size, axillary and internal mammary node metastases, and 21N status. Among the patients with axillary node involvement, however, 21N status did not appear to be a significant additional prognostic factor. Internal mammary node metastases were significant. In a multivariate study, only axillary and internal mammary node metastases were significant prognostic factors for either the entire group of patients or those with positive axillary nodes. Therefore, axillary node dissection and biopsy of the internal mammary nodes may provide important prognostic information for patients with breast cancer.

Adult↗

PubMed1992

Stereologic, histopathologic, flow cytometric, and clinical parameters in the prognostic evaluation of 74 patients with intraoral squamous cell carcinomas.

BACKGROUND AND METHODS: A consecutive series of all 78 incident cases of intraoral squamous cell carcinoma occurring during a 2-year period in a population of 1.4 million inhabitants were evaluated by histologic score (the modified classification of Jacobsson et al.), flow cytometry, stereology, tumor size, and the TNM classification. RESULTS: The investigation showed a significant difference between the volume-weighted mean nuclear volume (nuclear vv) of oral leukoplakia (n = 29) and oral squamous cell carcinomas (P = 0.001). The value of the parameters as prognostic indicators of survival and recurrence was tested with Kaplan-Meier plots and Cox multiple hazard regression analysis. Tumor size, T-stage, stereologically estimated nuclear vv, and mean nuclear profile area were all of significant prognostic value in single factor analysis with reference to both survival and recurrence. The histologic parameters of mitotic activity, morphologic nuclear dedifferentiation, and histologic mean malignancy score and the DNA ploidy level had no prognostic value. A prognostic index based on the results of the Cox analysis that included T-stage and nuclear vv was correlated highly with survival (P = 0.00001) and recurrence (P = 0.002). CONCLUSION: These findings may contribute to optimal and individualized therapy.

Adult↗

PubMed1992

Prognostic factors. Stage and receptor status in breast cancer.

BACKGROUND: Anatomic and biologic indicators of prognosis provide the bases for management of patients with cancer of the breast. Combinations of these indicators are potentially more accurate than any alone. This review was undertaken to evaluate the prognostic relationship between stage and steroid hormone receptors. METHODS: The literature was reviewed relative to the influences of tumor size, axillary metastases, and tumor estrogen receptors on the survival of patients with cancer of the breast. RESULTS: Axillary node status is of primary importance as a predictor of recurrence and survival. Tumor size has only a secondary influence, but is prognostically useful in the absence of metastases. Estrogen and progesterone receptors provide prognostic information that is independent of axillary stage, but the influence is weak, often transient, and attributable at least partly to a close association with other biologic indicators of favorable prognosis. CONCLUSIONS: Hormone receptors add to the prognostic information provided by anatomic stage, but the contribution is insufficient to support a decision for or against systemic adjuvant therapy.

Breast Neoplasms↗

PubMed1992

Erythrocyte sedimentation rate as a tumor marker in human prostatic cancer. An analysis of prognostic factors in 300 population-based consecutive cases.

BACKGROUND: The natural history of prostatic cancer is variable. Our knowledge of prognostic factors is limited; therefore, research is needed. METHODS: The cases of 300 population-based consecutive patients with a diagnosis of cancer of the prostate were analyzed regarding different prognostic factors (but with special reference to the erythrocyte sedimentation rate [ESR]). RESULTS: After a mean observation time of 100 months, M category, ESR, grade, performance status, hemoglobin level, and T category were found to correlate with disease-specific death using multivariate analysis. The variables correlating with progression in the multivariate model were M category, ESR, T category, grade, treatment, and age. Patients treated with estrogen had a significantly lower risk (relative hazard, 0.3) of relapse. ESR was highly statistically significant (P less than 0.0001) as a prognostic factor. With the variable in linear form, a 20-mm/h higher level suggested a 29% increased risk, on average, for dying of prostatic cancer (using a best-fit multivariate model). However, the relationship was not linear. After correcting for the effect of other factors, the risk for dying of prostatic cancer was lowest when the ESR was 40-50 mm/h and highest when its values were highest. CONCLUSIONS: ESR is an indicator of increased risk of progression and death in prostatic cancer. Other prognostic factors such as M and T categories, grade, performance status, hemoglobin level, and age currently are more important when planning treatment. It is possible that the ESR reflects aspects of tumor-host relationship and that both a low and high ESR are markers for patients with receding host defence mechanism.

Aged↗

PubMed1992

Prognostic significance of histologic parameters of soft tissue sarcomas.

BACKGROUND AND METHODS: A univariate and multivariate analysis for the correlation between histomorphologic factors and prognosis was made using data from 1116 patients with soft tissue sarcoma, including 1005 cases available with complete histologic and follow-up data. RESULTS: The overall 5-year survival rate was 43.6%. The univariate analysis using Kaplan-Meier survival curves showed that tumor differentiation, cellularity, nuclear atypia, cellular pleomorphism, mitotic activity, amount of fibrous stroma, extent of myxoid areas, extent of tumor necrosis, and histologic grading (determined by the estimated range of malignancy for each type of sarcoma using a reported guideline) were all significant prognostic factors in the overall soft tissue sarcoma group. By a multivariate analysis using a procedure based on the Weibull model to failure data, the histologic grading and extent of tumor necrosis were proved to be prognostically significant in the overall sarcoma group. However, after additional analysis on each histologic type of sarcoma, it was determined that both tumor necrosis and histologic grading were applicable in only two types: malignant fibrous histiocytoma and leiomyosarcoma. Liposarcoma, synovial sarcoma, and malignant schwannoma each also showed some determinable factor of prognostic significance. CONCLUSIONS: It was concluded that there seemed to be no single universal prognostic parameter that could be applied to each soft tissue sarcoma type. These results suggest that the predictive significance of the various histologic parameters should be based on each specific type of sarcoma.

Adolescent↗

PubMed1993

Cutaneous malignant melanoma of the head and neck. Analysis of treatment results and prognostic factors in 581 patients: a report from the Swedish Melanoma Study Group.

BACKGROUND: Results of surgical treatment of cutaneous malignant melanoma (CMM) have been highly variable, probably because of patient selection. Therefore, a study of representative patients with this disease was performed. METHODS: In a defined area of Sweden, 581 patients were analyzed. Clinical records and histopathologic findings were reviewed. The minimum follow-up time was 7 years. Prognostic factors were evaluated by the Cox proportional hazards model. RESULTS: Evaluation of sex distribution, age, and anatomic site of the primary tumor showed that the patients were representative of all Swedish patients with CMM of the head and neck. The mean patient age at diagnosis was 64 years for both sexes. Fifty-three percent of the patients were women. Female patients had more tumors of the face than did male patients, whereas male patients were overrepresented among patients with tumors of the auricle-external ear canal and scalp-neck area. Localization to the face was observed in 68%, which is an overrepresentation of three to four times when skin surface is taken into consideration. Twenty-four percent of the patients had lentigo maligna melanoma. Only 33% of the patients had superficial spreading melanoma. In univariate analyses, sex, anatomic site of the primary tumor, histogenetic type, Clark level of invasion, and tumor thickness had prognostic power. In a multivariate analysis, tumor thickness, anatomic site of the primary tumor, and sex of the patient were independent prognostic factors. CONCLUSIONS: In representative patients with CMM of the head and neck, tumor thickness, anatomic site of the primary tumor, and sex of the patients were independent prognostic factors.

Age Factors↗

PubMed1993

How to integrate steroid hormone receptor, flow cytometric, and other prognostic information in regard to primary breast cancer.

A large group of patients with node-positive breast cancer was divided into a training set (n = 851) and a validation set (n = 432) to demonstrate techniques for integrating steroid hormone receptor status, DNA flow cytometric findings, and other prognostic factors to predict patient survival. Multivariate analyses showed that estrogen receptor status, the number of involved axillary lymph nodes, patient age, S-phase fraction, progesterone receptor status, and tumor size were significant predictors of survival in patients with node-positive breast cancer. Techniques for optimizing and validating a cut point for a new prognostic factor and for examining alternative representations of prognostic factors were demonstrated. Prognostic indexes were created that could be used to identify patients with very good or very poor prognoses.

Aneuploidy↗

PubMed1993

Prognostic factors in laryngeal carcinoma. Experience in 296 male patients.

BACKGROUND: Laryngeal cancer is the primary cause of death among patients with head and neck cancer in Argentina. Different prognostic factors have been incidentally dealt with in a number of articles, but there are few studies of prognostic variables, such as age, tobacco, and alcohol, using multifactorial analysis. METHODS: Between 1969-1987, 296 male patients with epidermoid carcinoma of the larynx treated at the Institute of Oncology "Angel H. Roffo" were studied regarding prognostic factors of survival. The effect of age, tobacco, alcohol, histologic grade, extent of primary tumor, and cord mobility on survival were assessed by means of the Cox proportional-hazards model. RESULTS: The univariate analysis showed that primary tumor extent, nodal involvement, stage, alcohol intake, previous tracheostomy, and cord mobility were statistically significant predictors of survival. Multivariate analysis disclosed only nodal involvement, alcohol intake, and cord mobility as statistically significant variables in regard to survivorship. With these variables, a hazard index was calculated for each patient, and four risk groups were formed. Five-year survival rates were as follows: Group A, 79%; B, 69%; C, 47%; and D, 14% (A versus C, P < 0.005; A versus D, P < 0.005). CONCLUSIONS: This study confirmed the prognostic impact of nodal involvement and also showed the importance of cord fixation and alcohol drinking as predictors of survival.

Aged↗

PubMed1993

Prognostic significance of immunohistochemical analysis of cathepsin D in low-stage breast cancer.

BACKGROUND: Cathepsin D is an estrogen-regulated lysosomal protease that may be overexpressed in breast cancer. Several studies based on biochemical analysis of tumor cytosol have shown that high levels of cathepsin D are associated with poor outcome in patients with breast cancer. In contrast, a few immunohistochemical studies have shown that cathepsin D positivity in breast cancer cells indicates a favorable prognostic outcome or is of no prognostic significance. METHODS: Because of the current controversy, the authors studied, using immunohistochemistry, the distribution (0 to 3) and intensity (0 to 3) of cathepsin D in Stage I and II infiltrating ductal carcinoma of the breast from 245 patients treated at the City of Hope National Medical Center, Duarte, California, from 1970 to 1986. A commercially available rabbit antiserum to purified human cathepsin D and the standard avidin-biotin complex method were used. Statistical analysis was based on a combined low (0 or 2) or high (3 to 6) score. RESULTS: A high cathepsin D score was associated with Stage II disease (P = 0.007), positive lymph nodes (P = 0.019), high nuclear grade (P = 0.005), and c-erbB-2 oncogene amplification (P = 0.013). Cathepsin D positivity was not an independent prognostic indicator of disease-free survival (DFS) or overall survival (OS). In a subgroup analysis, the presence of cathepsin D had only a modest association with predicting a shorter DFS in patients with negative lymph nodes (P = 0.072) or positive progesterone receptors (PR) (P = 0.086). CONCLUSIONS: Immunohistochemical analysis of cathepsin D, with the antiserum used in this study, is not an independent predictor of outcome in patients with breast cancer because of its strong associations with several well-established prognostic indicators.

Adult↗

PubMed1993

MACOP-B +/- radiation therapy for diffuse large cell lymphoma. Analysis of the Stanford results according to prognostic indices.

BACKGROUND: The efficacy and toxicity of the MA-COP-B regimen were assessed after outstanding results were reported in diffuse large cell lymphoma (DLCL) by the Vancouver group. The results are reported according to several proposed prognostic indices, including the recent International Prognostic Factors (IPF) Project. METHODS: Forty-seven patients with untreated DLCL received MACOP-B chemotherapy. Thirty patients, most of whom had bulky disease, also received consolidative radiation therapy (RT). Patient characteristics include median age of 42 years, Stage III/IV (57%), bulky or symptomatic Stage II disease (43%), elevated lactic dehydrogenase (81%) and at least one extranodal site (72%). RESULTS: At a median follow-up of 3.3 years, overall survival was 57% and freedom from progression (FFP) was 52%. The 3-year FFP data were related to tumor extent: 74% for limited stage versus 38% for extensive disease. These data correlated well with four prognostic indices reported in the literature. The IPF index accurately identified low-, intermediate-, and high-risk subgroups. CONCLUSIONS: Patients with limited or low-risk DLCL have an excellent prognosis with MACOP-B +/- RT. These results do not support the use of consolidative high-dose therapy and bone marrow transplantation in patients with limited disease, even if bulky or accompanied by an elevated lactic dehydrogenase. Compared to historical CHOP data, MACOP-B +/- RT does not appear to improve outcome for those patients with poor prognostic features, most of whom will fail. The IPF index is a simple, accurate method of distinguishing high-risk patients who require new therapeutic initiatives.

Adult↗

PubMed1993

The prognostic value of immunohistochemical staining for proliferating cell nuclear antigen in synovial sarcoma.

BACKGROUND: The biologic behavior of synovial sarcoma remains a matter of controversy. Some investigators considered proliferative activity to be an important prognostic factor in this tumor. METHODS: Fifty-six patients with synovial sarcoma were immunohistochemically studied with PC10, a monoclonal antibody to proliferating cell nuclear antigen (PCNA). The percentage of nuclear areas with positive staining for PCNA (PCNA score), quantified by using an image analyzer, was compared with nuclear atypia, tumor necrosis, mitoses, and survival. Fifty-one patients were available for survival analysis. DNA flow cytometry was performed on 30 patients and compared with PCNA score and survival. The prognostic variables were analyzed with a multivariate technique using the Cox hazard model. RESULTS: Nuclear atypia (mild, 14; moderate, 23; severe, 14), mitosis (low, 34; high, 17), and tumor necrosis (< 50%, 37; > 50%, 14) were found to highly affect survival in the log-rank test (P < 0.01). Sixteen patients with a high (> or = 12.5) PCNA score had a worse survival (P < 0.01) than did the 35 patients with a low (< 12.5) PCNA score. In patients in whom DNA flow cytometry was performed, the S+G2M-phase fraction showed no correlation with the clinical outcome. However, there was a significant relationship between the extent of PCNA staining and S+G2M fraction (correlation coefficient [CC] = 0.54; P = 0.002), although the CC between PCNA staining and the mitotic count was only 0.38. However, the ploidy pattern was not related to PCNA scores or prognosis. In a multivariate analysis, a high PCNA score (P = 0.017) and severe nuclear atypia (P = 0.0003) were strong prognostic factors. CONCLUSIONS: The results suggest that a high PCNA score is one of the poor prognostic factors in synovial sarcoma.

Adolescent↗

PubMed1993

Prognostic importance of histologic grading in papillary thyroid carcinoma.

BACKGROUND: The influence of various clinicopathologic features on survival of patients with papillary thyroid carcinoma has been examined. In particular, histologic grade, which was obtained by a combined assessment of nuclear atypia, tumor necrosis, and vascular invasion (VAN score) was studied. According to this, histologic grade is independent of growth pattern and differentiation of the tumor cells. METHODS: One hundred seventy-three consecutive patients were studied retrospectively, and most were treated with total/near-total thyroidectomy. Univariate (life-table) and multivariate (Cox regression) analyses of thyroid cancer deaths were performed. RESULTS: Histologic grade showed a highly significant prognostic impact. It was possible to discriminate between low-grade (Grade 1) and high-grade (Grade 2) tumors, occurring in 79% and 21% of the patients, respectively. The risk of thyroid cancer deaths was found to be considerably higher in the latter group of patients. When histologic grade was combined with sex and age, a highly significant prognostic score (the SAG score) was obtained. CONCLUSION: Histologic grade based on nuclear atypia, tumor necrosis, and vascular invasion is a strong and independent prognostic factor. When combined with patient sex and age, the final SAG score and the pTNM-age classification were both significant and should be considered in prognostic stratification of these patients.

Adolescent↗

PubMed1994

Primary prognostic factors in invasive breast cancer with special reference to ductal carcinoma and histologic malignancy grade.

BACKGROUND: In a study of 2290 cases of invasive breast cancer in Malmö, the prognostic value of histologic typing and axillary nodal status was examined. Two periods were studied: Period 1, 1961-1970, and Period 2, 1981-1988. METHODS: All primarily unilateral invasive breast cancers were included in the study and classified according to the histologic classification proposed by Linell et al. and Linell and Ljungberg (the Linell-Ljungberg classification), which includes a histologic grading of ductal carcinoma based on content of tubular structures. From Period 1, the tumors were reclassified. In Period 2, the Linell-Ljungberg classification was used as a clinical routine. Median follow-up in Period 1 was 23 years, and in Period 2, 5 years. Survival was calculated in relation to histologic type and axillary nodal status. RESULTS: The Linell-Ljungberg classification divides invasive ductal carcinoma (IDC) into two groups of approximately equal size: IDC of comedo type, 40% of total; and IDC of tubuloductal type, 30% of total. There was a significantly better survival rate in the tubuloductal group than in the comedo group. In a multivariate analysis, this difference was shown to be independent of axillary nodal status and tumor size. By combining histologic classification with axillary nodal status, one group of patients could be identified containing 90% of patients dying from breast cancer within 5 years of diagnosis and another group with less than 10% risk of dying from breast cancer within 5 years. CONCLUSIONS: Valuable prognostic information can be obtained in a clinical setting from routinely obtained primary prognostic factors in breast cancer: pTNM stage, histologic type, and histologic malignancy grade. This information should be considered the baseline in the clinical evaluation of other more elaborate prognostic factors.

Adult↗

PubMed1994

Near-diploidy: a new prognostic factor for clinically localized prostate cancer treated with external beam radiation therapy.

BACKGROUND: DNA ploidy is a significant prognostic factor in patients with prostate cancer. Using DNA/nuclear protein flow cytometry, a subpopulation of tumors with near-diploid DNA is identifiable. The prognostic significance of near-diploidy was examined. METHODS: Paraffin-embedded formalin fixed prostate tumor tissue from patients treated at M. D. Anderson Cancer Center with external beam radiation therapy was processed for DNA/nuclear protein flow cytometry. All patients had pretreatment and follow-up serum prostate specific antigen (PSA) levels. Seventy-six specimens were suitable for flow cytometric analysis. Tumors were classified as either diploid (n = 30), near-diploid (n = 24), or nondiploid (n = 22, tetraploid and aneuploid). Median follow-up time was 36 months. RESULTS: Diploid tumors were associated with a significantly better actuarial outcome at 4 years, compared with near-diploid tumors, using either biochemical relapse (rising PSA) or a composite end point of a rising PSA or clinical relapse (16% versus 52% relapse, P < 0.05, log-rank). Moreover, patients who had nondiploid tumors had the worst prognosis (77% relapse, composite end point). No significant difference was observed between diploid and near-diploid neoplasms regarding actuarial local control, freedom from metastasis, freedom from clinical relapse, or overall survival time. A Cox proportional hazards model, using the composite end point of a rising PSA or relapse, was performed with ploidy categorized as diploid, near-diploid, and nondiploid; pretreatment PSA, DNA ploidy, and tumor grade were found to be independent prognostic factors. When ploidy was categorized as diploid or near-diploid (nondiploid tumors excluded), pretreatment serum PSA and DNA ploidy were independent predictors of outcome. Ploidy remained an independent prognostic factor even when nondiploid tumors were excluded. CONCLUSIONS: These data show that patients who have near-diploid tumors have an intermediate prognosis between the more favorable diploid tumors and the less favorable nondiploid tumors.

Acid Phosphatase↗

PubMed1994

Protein induced by vitamin K absence or antagonist II as a prognostic marker in hepatocellular carcinoma. Comparison with alpha-fetoprotein.

BACKGROUND: Protein induced by vitamin K absence or antagonist II (PIVKA-II) was widely used as a diagnostic marker for hepatocellular carcinoma (HCC), however, its prognostic value is unclear. The authors evaluated PIVKA-II clinicopathologically as a prognostic marker for HCC. METHODS: The relationship between pathologic prognostic factors and plasma PIVKA-II and alpha-fetoprotein (AFP) was investigated in 72 patients with resectable HCC measuring less than 6 cm in greatest dimension. RESULTS: PIVKA-II shows significantly lower sensitivity, but higher specificity than AFP, and the use of these two complementary markers appears to be useful in the diagnosis of HCC. The frequencies of intrahepatic metastasis, portal vein tumor thrombus, hepatic vein tumor thrombus, and capsular infiltration were significantly higher in patients with positive PIVKA-II than in those with negative-PIVKA-II, and the recurrence-free rate was significantly lower in patients with positive rather than with negative PIVKA-II. However, there were no significant differences between the patients who were AFP positive and those who were AFP negative in pathologic prognostic factors and the recurrence-free rate. From univariate and multivariate analyses, the authors find that PIVKA-II is one of the risk factors for recurrence of HCC after hepatectomy. CONCLUSIONS: PIVKA-II may be a useful marker for the prediction of intrahepatic spread and for the prognosis of HCC. In addition, PIVKA-II-positive patients, thus, need aggressive postoperative adjuvant therapy for undetectable residual tumors and careful postoperative monitoring to enable the early recognition of recurrence.

Adult↗