Publication Name	World Journal of Gastrointestinal Oncology
Manuscript ID	118297
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Letter to the Editor
Article Title	Protein induced by vitamin K absence or antagonist-II: A promising predictive marker in hepatocellular carcinoma with normal alpha-fetoprotein
Manuscript Source	Invited Manuscript
All Author List	Xi-Ming Wang, Hui-Gang Li, Jin-Xin Xu, Xiang Wu and Hong Li
Funding Agency and Grant Number
Corresponding Author	Hong Li, Full Professor, Li Huili Hospital Affiliated to Ningbo University, No. 57 Xingning Road, Yinzhou District, Ningbo 315000, Zhejiang Province, China. lihong196311@163.com
Key Words	Hepatocellular carcinoma; Alpha-fetoprotein; Protein induced by vitamin K absence/antagonist-II; Des-gamma carboxy prothrombin; Aggressive tumor
Core Tip	We recently read an enlightening study published in the World Journal of Gastrointestinal Oncology that examined the association between protein induced by vitamin K absence/antagonist-II (PIVKA-II) and hepatocellular carcinoma. The results indicate that PIVKA-II provides additional biological information beyond the conventional biomarker alpha-fetoprotein, and is closely associated with aggressive pathological features, including microvascular invasion and increased tumor cell proliferation. Overall, this study supports a shift from single-biomarker measurements toward systems-level risk stratification. Prospective validation remains warranted, and integrating PIVKA-II with imaging-defined tumor burden and vascular invasion risk may better guide surveillance intensity, treatment escalation and transplant-related decision-making.
Citation	Wang XM, Li HG, Xu JX, Wu X, Li H. Protein induced by vitamin K absence or antagonist-II: A promising predictive marker in hepatocellular carcinoma with normal alpha-fetoprotein. World J Gastrointest Oncol 2026; In press

Received	2025-12-30 06:00
Peer-Review Started	2025-12-30 06:00
First Decision by Editorial Office Director	2026-01-06 07:10
Return for Revision	2026-01-06 07:10
Revised	2026-01-17 09:09
Publication Fee Transferred
Second Decision by Editor	2026-02-24 02:52
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-02-24 07:54
Articles in Press	2026-02-24 07:54
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-5204 (online)
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