Abstract: Objective To explore the value of serum Dickkopf-1 related protein (DKK1), tumor abnormal protein (TAP) combined with protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) in preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Methods A total of 270 HCC patients diagnosed and treated in Qidong People′s Hospital from September 2021 to August 2024 were regarded as the HCC group, and 247 patients with benign liver lesions and 283 physical examination volunteers were selected as the benign group and control group. HCC patients were assigned into non-MVI group (n=176) and MVI group (n=94) based on whether MVI occurred. Quantitative hepatitis B virus (HBV) DNA, prothrombin time (PT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), alpha-fetoprotein (AFP), DKK1, PIVKA-Ⅱ and TAP levels were determined. Multivariate logistic regression was applied to analyze the influencing factors of MVI occurrence. The ROC curve was applied to analyze the diagnostic value of DKK1, TAP, and PIVKA-II for the occurrence of MVI. The Z-test was applied to compare the difference in AUC. Results The levels of serum DKK1, TAP and PIVKA-Ⅱ in HCC group were (147.95±45.36) pg/L, (184.90±58.72) μm² and (124.47±38.31) ng/mL, respectively higher than the benign group [(115.32±34.31) pg/L, (126.37±38.32) μm², (75.28±24.74) ng/mL] and the control group [(96.45±28.44) pg/L, (86.21±25.34) μm², (32.71±8.43) ng/mL]. Compared with the non-MVI group, the MVI group had tumors with a diameter of ≥ 5 cm, multiple tumors, low tumor differentiation, HBV DNA quantification >10⁴ copies/mL, a higher proportion of Child Pugh grade B, and higher levels of serum AFP, DKK1, TAP, and PIVKA Ⅱ (P<0.05). Tumor diameter ≥ 5 cm, multiple tumors, low tumor differentiation, and elevated levels of AFP, DKK1, TAP, and PIVKA-Ⅱ were independent risk factors for MVI in HCC patients (P<0.05). The AUC values of DKK1, TAP, and PIVKA-Ⅱ for diagnosing MVI in HCC patients were 0.773, 0.788, and 0.777, respectively. The AUC of the combined diagnosis of the three was 0.934, which was better than the individual diagnosis. Conclusion The levels of serum DKK1, TAP, and PIVKA Ⅱ in patients with MVI are higher than those in non-MVI patients, and these three are independent risk factors for the occurrence of MVI. The combined diagnosis of MVI has certain clinical significance and provides reference for clinical diagnosis.

Key words: Hepatocellular carcinoma, Dickkopf-1 related protein, Tumor abnormal protein, Protein induced by vitamin K absence or antagonist-Ⅱ, Microvascular invasion, Diagnostic value