You are about to leave the Clinical Value website now.


Urgent Global Need for PIVKA-II and AFP-L3 Measurements for Surveillance and Management of Hepatocellular Carcinoma

Quick Summary

The incidence of AFP-negative HCC is increasing worldwide, particularly HCCs of nonviral etiology, such as MASLD/MASH. A high percentage of patients with MASLD/MASH-related HCC are positive for PIVKA-II, even those who are negative for AFP[1]. Higher levels of AFP-L3 have also been reported in cases of MASLD/MASH-related HCC [2]. Thus, the role of PIVKA-II and AFP-L3 measurements in HCC surveillance and diagnosis of AFP-negative HCCs has become more important.
This article by Prof Masatoshi Kudo details the importance of testing all 3 biomarkers, AFP, AFP-L3, and PIVKA-II, in HCC surveillance and management. He also discusses new algorithms, such as GALAD and GAAD, which incorporate these biomarkers have been useful in countries where access to imaging is limited.


  1. Best J, Bechmann LP, Sowa JP, Sydor S, Dechêne A, Pflanz K, Bedreli S, Schotten C, Geier A, Berg T, Fischer J, Vogel A, Bantel H, Weinmann A, Schattenberg JM, Huber Y, Wege H, von Felden J, Schulze K, Bettinger D, Thimme R, Sinner F, Schütte K, Weiss KH, Toyoda H, Yasuda S, Kumada T, Berhane S, Wichert M, Heider D, Gerken G, Johnson P, Canbay A. GALAD Score Detects Early Hepatocellular Carcinoma in an International Cohort of Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol. 2020 Mar;18(3):728-735.e4. doi: 10.1016/j.cgh.2019.11.012. Epub 2019 Nov 8. PMID: 31712073.
  2. Nouso K, Furubayashi Y, Kariyama K, Wakuta A, Miyake N, Inoue K, Nagai Y, Murakami S, Adachi T, Oyama A, Wada N, Takeuchi Y, Sakata M, Yasunaka T, Onishi H, Shiraha H, Takaki A, Shiota S, Yasuda S, Toyoda H, Kawanaka M, Kumada T, Okada H. Abnormal fucosylation of alpha-fetoprotein in patients with nonalcoholic steatohepatitis. Hepatol Res. 2021 May;51(5):548-553. doi: 10.1111/hepr.13626. Epub 2021 Mar 19. PMID: 33596344.

You May Also Like

13 May 2024

No woman left behind: Increasing access to testing for cervical cancer elimination

Read More
13 May 2024

Advancing women’s health: Project Teal drives cervical cancer screening in Hong Kong

Read More


Be the first to receive updates, event opportunities, and thought leadership insights.