Prof Grace Wong shares recommendations from the recent HKASLD Consensus on the use of PIVKA-II for HCC surveillance and detection.
Interview transcript:
What is the current liver disease landscape in Hong Kong?
In Hong Kong, the commonest chronic liver disease is chronic hepatitis B and metabolic associated steatotic liver disease, or in short MAFLD. So these two diseases affect in total more than a million out of 7.5 million population in Hong Kong. Because of the heavy disease burden, the HCC (Hepatocellular Carcinoma) surveillance for patients with chronic liver disease has been suboptimal, because of the very long waiting time for surveillance ultrasound.
Based on the recent HKASLD consensus recommendations, how can Hong Kong clinicians use PIVKA-II in their HCC surveillance practice?
We find that our current practice using alpha fetoprotein (AFP) will be helpful in HCC surveillance. But we also noticed that roughly around a third of the patients who have HCC diagnosed will have normal AFP (levels). So in a recent pilot study in Hong Kong, organized by the Hong Kong Association for the Study of Liver Diseases (HKASLD), we found PIVKA-II would be helpful to further increase the sensitivity of detecting early HCC. So we will advise clinicians to consider using both tumor markers, AFP and PIVKA-II, together in patients who need HCC surveillance.
How can clinicians overcome the current challenges highlighted in the consensus when incorporating PIVKA-II testing into HCC surveillance practice in Hong Kong?
At this moment, we find that using both tumor markers for HCC surveillance probably is only limited to some high risk populations. In fact, our association has been discussing with the government to prioritize patients who are at high risk of HCC, namely those with liver cirrhosis to have both AFP and PIVKA-II tumor markers as part of the screening. But we also advocate for patients who can afford paying for the tumor markers themselves, they can also consider to use PIVKA-II together with AFP in a private setting.
What advice would you give clinicians who are looking to improve their HCC surveillance strategy?
I think good communications with patients and their family is important. They have to understand the importance to adhere to regular HCC surveillance as well as to use the very sensitive tools. So, apart from the current standards: ultrasound together with AFP, we will strongly recommend to also use PIVKA-II in patients who are at high risk.
The views and opinions expressed by Prof. Grace Wong are her own views and opinions. Roche disclaims all liability in relation to these views and opinions.
