Serum Pivka-Ii Profiling for Hepatocellular Carcinoma Detection in Balochistan: A Cross-Sectional Diagnostic Study

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Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with delayed diagnosis contributing to poor outcomes in resource-limited regions. Protein Induced by Vitamin K Absence-II (PIVKA-II), a non-functional prothrombin variant, has emerged as a promising biomarker for HCC detection and risk stratification. This study investigates serum PIVKA-II levels in a regional cohort from Balochistan, Pakistan, to evaluate its diagnostic performance and demographic associations. Methods: A cross-sectional analysis was conducted on 34 patients undergoing liver disease evaluation. Serum PIVKA-II concentrations were measured using Chemiluminescent Microparticle Immunoassay (CMIA) and stratified into three diagnostic categories: Healthy (≤43 mAU/mL), Borderline (44–147 mAU/mL), and HCC (≥148 mAU/mL). Age and gender distributions were analyzed to identify epidemiological trends. Results: Of the 34 participants (25 males, 9 females; age range: 38–75 years), 19 (55.9%) exhibited PIVKA-II levels consistent with HCC, 2 (5.9%) were borderline, and 13 (38.2%) fell within the healthy range. HCC-range elevations were most frequent in males aged 60–69 years. Notably, one male aged 30–39 presented with an extreme elevation (>30,000 mAU/mL), suggesting possible early-onset or aggressive disease. Overall, 74% of HCC-range cases were male, reinforcing known gender disparities in HCC prevalence. Conclusion: PIVKA-II demonstrates strong diagnostic utility for HCC in this underserved population, with clear age and gender correlations. Its integration into routine screening protocols may enhance early detection, particularly in high-risk male cohorts. Further multicenter studies incorporating AFP and molecular profiling are warranted to validate dual-marker strategies and optimize diagnostic algorithms for liver malignancies in low-resource settings.