Background: As a promising biomarker of hepatocellular carcinoma (HCC), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-II) has been studied extensively. However, its diagnostic capability varies across HCC studies. This study aimed to compare the performance of PIVKA-II with alpha-fetoprotein (AFP) in the diagnosis of HCC. Data sources: A systematic literature search was conducted to identify the studies from MEDLINE, Em-base and Cochrane Library Databases, which were published up to December 20, 2017 to compare the diagnostic capability of PIVKA-II and AFP for HCC. The data were pooled using random effects model. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curve (ROC) was employed to evaluate the diagnostic accuracy of each marker. Results: Thirty-one studies were included. The pooled sensitivity (95％ CI) of PIVKA-II and AFP was 0.66 (0.65–0.68) and 0.66 (0.65–0.67), respectively in diagnosis of HCC; and the corresponding pooled speci-ficity (95％

Hepatobiliary & pancreatic diseases international

Meta-analyses; Hepatocellular carcinoma; Protein induced by vitamin K absence or antagonist-; Alpha-fetoprotein