ObjectiveTo investigate the value of abnormal prothrombin ［protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)］ in monitoring the short-term efficacy of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). MethodsA retrospective analysis was performed for the clinical data of 114 patients with HCC who were admitted to Zhongda Hospital Affiliated to Southeast University from January to December, 2019, and all patients received conventional TACE alone and had a baseline PIVKA-Ⅱ level of ≥40.00 mAU/ml. Serological response of PIVKA-Ⅱ was observed before TACE and at 1, 3, and 6 months after TACE and was compared with radiological response at the same time point (based on mRECIST guidelines). A Spearman correlation analysis was used to investigate the correlation between serological response and radiological response. The paired chi-square test was used to analyze the consistency between the sensitivity of serological response and that of radiological response. Radiological response was used as the gold standard to investigate the validity and reliability assessment indices of the serological response of PIVKA-Ⅱ. ResultsThe patients enrolled in this study had a PIVKA-Ⅱ level of 7225.44 (40.13-30 000.00) mAU/ml. At 1, 3, and 6 months after TACE, 104 patients (91.2%), 94 patients (90.3%), and 86 patients (90.5%), respectively, had serological response, while 103 patients (903%), 90 patients (86.5%), and 82 patients (86.3%) had radiological response. The Spearman correlation analysis showed that radiological response was positively correlated with serological response at 1, 3, and 6 months after TACE (r=0.739, 0.731, and 0.708, all P＜0001). The paired chi-square test showed that serological response and radiological response had a relatively consistent sensitivity in assessment at 1, 3, and 6 months after TACE (χ2=0, 1.5, and 1.5, P=1.000, 0.219, and 0.219). The validity and reliability assessment indices of serological response maintained at a relatively high level. ConclusionBased on the criteria for radiological response, PIVKA-Ⅱ has a good value in monitoring the short-term efficacy of TACE in patients with HCC.