肝细胞癌（HCC）是最常见的原发性肝癌类型，死亡率很高。 HCC 精准医疗的实现依赖于高效的生物标志物。维生素 K 缺乏或拮抗剂 II 诱导的蛋白 (PIVKA-II) 是一种不成熟的凝血酶原，凝血活性不足，在 HCC 细胞中过度表达。先前的证据证实了 PIVKA-II 在筛查和诊断 HCC 中的作用。然而，PIVKA-II 的增加不仅在 HCC 中观察到，而且在非 HCC 个体（例如维生素 K 缺乏）中也观察到。 PIVKA-II与其他生物标志物的联合检测可显着提高HCC的诊断准确性。此外，PIVKA-II 可作为有价值的预后预测因子、移植资格、可切除性、肿瘤复发、治疗效果和恶性肿瘤行为。此外，PIVKA-II 代表了药物开发的潜在目标，以建立新的治疗策略。除了 HCC 之外，PIVKA-II 还可以作为维生素 K 状态的生物标志物。在这篇综述中，我们评估了 PIVKA-II 在诊断、预测和治疗中的作用。过去几十年来，PIVKA-II的应用取得了实质性进展。 PIVKA-II 研究领域的进一步发展需要探索和创新。版权所有 © 2023。由 Elsevier B.V. 出版。

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer with high mortality. The realization of precision medicine in HCC relies upon efficient biomarkers. Protein induced by vitamin K absence or antagonist II (PIVKA-II) is an immature prothrombin with insufficient coagulation activity, overexpressing in HCC cells. Previous evidence confirmed the role of PIVKA-II in screening and diagnosing HCC. However, the increased PIVKA-II was observed not only in HCC, but also in non-HCC individuals such as vitamin K deficiency. The joint detection of PIVKA-II and other biomarkers could significantly improve diagnostic accuracy in HCC. Furthermore, PIVKA-II serves as a valuable prognostic predictor, transplantation eligibility, resectability, tumor recurrence, therapeutic efficacy, and malignant tumor behaviors. Additionally, PIVKA-II represents a potential target for agent development to establish new therapeutic strategies. Besides HCC, PIVKA-II also serves as a biomarker of vitamin K status. In this review, we assess the role of PIVKA-II in diagnosis, prediction, and treatment. Over the past decades, substantial progress has been achieved in the application of PIVKA-II. Exploration and innovation are required for further advances in the field of PIVKA-II investigation.Copyright © 2023. Published by Elsevier B.V.