Prediction of Post-resection Prognosis Using the ADV Score for Huge Hepatocellular Carcinomas ≥13 cm

Abstract

Background/aims: Multiplication of α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV score) is a surrogate marker for post-resection prognosis of hepatocellular carcinoma (HCC). This study aimed to validate the predictive power of the ADV score-based prognostic prediction model for patients with solitary huge HCC.

Methods: Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥13 cm between 2008 and 2012 were selected.

Results: The median tumor diameter and tumor volume were 15.0 cm and 886 mL, respectively. Tumor recurrence and overall survival (OS) rates were 70.7% and 66.0% at one year and 84.9% and 34.0% at five years, respectively. Microvascular invasion (MVI) was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS, stratified by ADV score with 1-log intervals, showed significant prognostic contrasts (P=0.007 and P=0.017, respectively). DFS and OS, stratified by ADV score with a cut-off of 8-log, showed significant prognostic contrasts (P=0.014 and P=0.042, respectively). The combination of MVI and ADV score with a cut-off of 8-log also showed significant prognostic contrasts in DFS (P<0.001) and OS (P=0.001) considering the number of risk factors. Prognostic contrast was enhanced after combining the MVI and ADV score.

Conclusions: The prognostic prediction model with the ADV score could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCC ≥13 cm. The results of this study suggest that our prognostic prediction models can be used to guide surgical treatment and post-resection follow-up for patients with huge HCCs.

Keywords: Hepatocellular carcinoma; Microvascular invasion; Recurrence; Resection; Tumor biology.

Figure 1

Comparison of preoperative computed tomography (CT) scan, resected right liver specimen, and CT scan taken 3 months after hepatic resection in patients who underwent right hepatectomy. The maximal tumor diameters were 13 cm (A), 17 cm (B), and 20 cm (C).

Figure 2

Kaplan-Meier estimation of post-resection tumor recurrence (A) and overall patient survival (B).

Figure 3

Comparison of the disease-free survival (A) and overall survival (B) curves according to the status of microvascular invasion (MVI).

Figure 4

Comparison of the disease-free survival (A) and overall survival (B) curves according to the α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV) score of 1log intervals.

Figure 5

Comparison of the disease-free survival (A) and overall survival (B) curves according to the α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV) score with a cut-off of 8.0log.

Figure 6

Comparison of the disease-free survival (A) and overall survival (B) curves according to the number of risk factors (presence of microvascular invasion and α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume [ADV] score ≥8.0log).