《T a b l e4Di a g n o s t i c a c c u r a c y o f PIVKA-II, AFPf o r\n\t\t\t\t\td i f f e r e

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《Protein induced by vitamin K absence or antagonist-Ⅱ versus alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: A systematic review with meta-analysis》

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A FP:a l p h a-f e t o p r o t e i n；AUC:a r e a u n d e r t h e ROCc u r v e；DOR:d i a g n o s t i c o d d s r a t i o；PIVKA-II:p r o t e i n i n d u c e d b y v i t a m i n Ka b s e n c e o r a n t a g o n i s t-II.

Serum markers for early diagnosis of patients with high risk of HCC offer an opportunity to decrease HCC mortality and reduce medical costs.In this meta-analysis，the greater AUC of PIVKA-II（0.856）over AFP（0.770）proves that PIVKA-II is better than AFP for detecting HCC.Furthermore，while the sensitivity of PIVKA-II was comparable to that of AFP in detecting small HCC（<3 cm），both the specificity and AUC of PIVKA-II were significantly higher than those of AFP.In subgroup analysis of ethnic groups，The AUC of PIVKA-II was significantly higher than that of AFP in detecting HCC among American，European and African patients.Although AFP performed better in African patients in specificity，higher sensitivity and AUC were found in PIVKA-II.In subgroup analysis of etiology，PIVKA-II performed better than AFP in detecting HBV-related，HCV-related or mixed-etiology HCC.Based on the results of subgroup analysis，we conclude that the diagnostic performance of PIVKA-II is worthy of further promotion in clinical practice.Please note that caution must be taken when interpreting the results of subgroup analyses because the number of studies was limited in this meta-analysis.Only one study was available for African patients and two studies for HCV-related HCC.The exclusion criteria in our study eliminated many Japanese studies in which HCV was the main cause of HCC，which affected the statistical power in the analysis of HCV-related HCC.In short，more studies are needed to allow more assertive conclusion to be made.