2019 Volume 60 Issue 1 Pages 39-45
We examined a 65 year-old-man diagnosed with hepatocellular carcinoma (HCC) 6 years ago, who had undergone repeated transcatheter arterial chemoembolization and radiofrequency ablation procedures. The patient was taking warfarin for the portal vein thrombosis, and thus lacked PIVKA-II measurements. Contrast-enhanced ultrasonography and computed tomography showed a 30-mm unenhanced liver tumor in the right hepatic lobe. We prescribed edoxaban instead of warfarin and measured his PIVKA-II values. The serum PIVKA-II level was high (952 mAU/mL). PET-CT revealed a high level of 18F-FDG accumulated in the tumor. Therefore, we diagnosed the patient to have HCC recurrence and assumed that the poorly differentiated hepatocellular carcinoma had rapidly progressed. In HCC patients, PIVKA-II has been useful as an index maker of the progression and of the malignant potential of tumors. We recommend the use of direct oral anticoagulants for patients with HCC.
