缺少维生素K所致的升高的蛋白-II (PIVKA-II) 已被证明是肝细胞癌 (HCC) 患者肝移植 (LT) 中的不良预后因素。目前还没有关于PIVKA-II对不分泌（≤20 ng/mL）甲胎蛋白 (AFP) 患者的LT后复发影响的确凿数据。我们报告了经过东西方HCC-LT联合会观察性回顾性研究。在2000年至2019年期间，有639名HCC患者在五个协作的欧洲和日本中心入组。为了减少最初的选择性偏见，采用了逆概率疗法加权 (IPTW) 方法对数据进行分析。在IPTW后的人群中，PIVKA-II (HR=2.00; 95％CI=1.52-2.64; p<0.001) 和AFP (HR=1.82; 95％CI=1.48-2.24; p<0.001) 是最相关的独立危险因素，影响LT后的复发。针对只关注不分泌AFP的患者的亚分析进一步证实了PIVKA-II的负面作用 (HR=2.06，95％CI=1.26-3.35; p=0.004)。将整个人群根据LT时的AFP水平（≤或>20 ng/mL）和PIVKA (≤或>300 mUA/mL) 分为四组，低AFP-PIVKA-II组的复发率最低（5年复发率=8.0%）。相反，高AFP-PIVKA-II组的结果最差（5年复发率=35.1%）。PIVKA-II的分泌是LT后HCC复发的一个相关危险因素，其作用与AFP状态无关。在LT情况下，结合这两个肿瘤标志物，对于预测LT后肿瘤复发风险并为这些患者选择移植治疗，具有重要意义。版权所有 ©2023美国肝病学研究协会。

Elevated Protein Induced by Vitamin-K Absence-II (PIVKA-II) has been shown to be an adverse prognostic factor in hepatocellular cancer (HCC) patients undergoing liver transplantation (LT). No definitive data are available about the impact of PIVKA-II concerning post-LT recurrence in patients not secreting (≤20 ng/mL) alpha-fetoprotein (AFP).An observational retrospective study of the East-West HCC-LT consortium is reported. Between 2000 and 2019, 639 HCC patients were enrolled in five collaborative European and Japanese centers. To minimize the initial selection bias, an inverse probability therapy weighting (IPTW) method was adopted to analyze the data. In the post-IPTW population, PIVKA-II (HR=2.00; 95%CI=1.52-2.64; p<0.001) and AFP (HR=1.82; 95%CI=1.48-2.24; p<0.001) were the most relevant independent risk factors for post-LT recurrence. A sub-analysis focusing only on AFP non-secreting patients confirmed the negative role of PIVKA-II (HR=2.06, 95%CI=1.26-3.35; p=0.004). When categorizing the entire population into four groups according to the AFP levels (≤ or >20 ng/mL) and PIVKA (≤ or >300 mUA/mL) at the time of LT, the lowest recurrence rates were observed in the low AFP-PIVKA-II group (5-year recurrence rate=8.0%). Conversely, the high AFP-PIVKA-II group had the worst outcome (5-year recurrence rate=35.1%).PIVKA-II secretion is a relevant risk factor for post-LT HCC recurrence. The role of this marker is independent of the AFP status. Combining both tumor markers, especially in the setting of LT, should be of great relevance for adding information about predicting the post-LT risk of tumor recurrence and selecting these patients for transplantation.Copyright © 2023 American Association for the Study of Liver Diseases.