Background: We aimed to validate the prognostic effect of the ADV score (alpha-fetoprotein [AFP], des-γ-carboxyprothrombin [DCP], tumor volume [TV] score, calculated as AFP [ng/mL]'DCP [mAU / mL]´TV [mL] and expressed in log10) for predicting patient survival after resection of hepatocellular carcinoma (HCC). The ADV score based on preoperative findings also showed great prognostic contrast in 1106 patients preoperatively diagnosed as having single naive tumor (p<0.001). Conclusions: This validation study strongly suggests that the ADV score is an integrated surrogate marker for postresection prognosis in HCC.
The ADV score is primarily applicable to patients with single naïve HCC and can be extended to those with multiple or pretreated HCCs. Comparison of overall patient survival curves according to ADV score based on preoperative findings ··· 19. Comparison of overall patient survival curves according to the tumor staging system and ADV score in group 1 and 2 patients ··· 21.
Therefore, the clinical impact of the ADV score needs to be externally validated in large multicenter cohorts. In this study, we evaluated the prognostic impact of ADV score in patients who underwent HCC resection and were registered in the Korean Liver Cancer Registry (KLCR) database. Patients who underwent locoregional treatment for HCC once before HR were assigned to treated tumor groups regardless of treatment response because such treatments change the values of the ADV score parameters.
The primary objective was to estimate overall patient survival according to the DSP score, and the secondary objective was to determine the cut-off values of the DSP score for clinical application.
Results
Clinical features of 1,390 patients who underwent liver resection for hepatocellular carcinoma by tumor number and preoperative treatment. Comparison of overall patient survival curves based on the number of tumors and preoperative treatment for hepatocellular carcinoma. In 1154 patients belonging to the naive single tumor group (Group 1), the association of AFP, DCP and TV is shown in two-dimensional scatter plots (Fig. 2).
Using cluster analysis, ADV scores were stratified as ADV ≤4.9log, ADV 5–. Comparison of overall patient survival curves in group 1 patients. By cluster analysis, ADV scores were stratified as ADV ≤4.9log, ADV 5–. Comparison of overall patient survival curves in Group 2 patients. A and B) Comparison according to the ADV scores of 1 log intervals and in 4 subgroups with cut-offs of 5 log, 7 log and 10 log in Group 3 patients .
C and D) Comparison according to the ADV scores of 1 log intervals and in 4 subgroups with cut-offs of 5 log, 7 log and 10 log in group 4 patients. Prediction of patient survival using the ADV score based on the preoperative finding in patients diagnosed with single naive HCC. Using cluster analysis, ADV scores were stratified as ADV ≤4.9log, ADV 5–. Comparison of patient overall survival curves by ADV score based on preoperative findings.
Analysis of survival by postoperative TNM stage and BCLC stage in patients diagnosed as naïve HCC. Comparison of overall patient survival curves according to tumor staging system and ADV score in group 1 and 2 patients. After limiting patients to TNM stage I and II: comparison of 4 subgroups with ADV cutoff of 5log, 7log and 10log in group 3 patients.
Discussion
DSP score-dependent prognostic stratification was validated in 1 single-center study and 1 multicenter study (3, 4), in which the DSP score was highly correlated with the postresection prognosis. The present study also showed that the DSP score was proportionally correlated with patient survival. To our knowledge, this is the first study to evaluate the prognostic impact of the DSP score in patients with multiple HCCs.
Although the number of patients with multiple tumors in this study was not large, we believe that the ADV score is reliably correlated with prognosis after resection. To apply the ADV score to multiple HCCs, the total TV was estimated as the TV of the largest tumor multiplied by the number of tumors. We believe that the ADV score calculated using a TV weighted by the number of tumors may partially compensate for the high prognostic impact of tumor multiplicity.
We previously studied the prognostic impact of the ADV score in patients with downstaged or recurrent HCCs after preoperative locoregional treatment (3). Unless a complete radiological or pathological response occurs, some viable tumor portions remain, allowing the ADV score to be calculated. Our previous study showed that the ADV score was still valid for preoperatively treated single HCCs (3).
We previously reported that the reliable cutoff for the ADV score in single naive HCC was 4log for tumor recurrence and 5log for patient survival (2, 3). The results in patients with a single naive tumor on preoperative imaging were similar to those of the postoperative ADV score. In contrast, additional application of the ADV score resulted in a noticeable improvement in prognostic contrast.
It is necessary to validate the ADV score in other geographic regions before extending our results to patients with HCC of various causes. In conclusion, this external validation study strongly suggests that the ADV score is an integrated surrogate marker for post-resection prognosis in HCC. We believe that the ADV score applies primarily to patients with a single naive HCC and can be extended to patients with multiple or pretreated HCCs.
종양 크기는 거시적 혈관 침범 없이 고립성 간세포 암종의 근치적 절제 후 장기 생존에 독립적으로 영향을 미치지 않습니다. 간세포암으로 간절제술 및 이식술을 받는 환자에서 TACE 유도 병리학적 완전관해의 예후 효과. 배경: 본 연구의 목적은 간세포암종 절제술에서 ADV 점수(alpha-fetoprotein[AFP], des-γ-carboxyprothrombin[DCP], 종양 부피 점수[TV])이다. 점수 계산은 다음과 같다: AFP[ng/ mL ]'DCP [mAU/mL]'TV [mL] 및 log10으로 표시됨. 각 값의 곱을 로그 스케일로 변환하여 계산됨)은 예후 평가의 유효성을 검증하는 데 있었습니다.
방법: KLCR(Korean Liver Cancer Registry)에 등록된 1390명의 환자를 대상으로 연구를 수행하였다. 결과: AFP, DCP 및 TV 간에 통계적으로 유의하며 DSP 점수를 구성합니다. TNM 병기(종양-결절-전이 병기) I 및 II와 BCLC 병기(Barcelona Clinic Liver Cancer 병기) 0 및 A인 환자만을 분석했을 때 DSP 점수의 컷오프 값은 평가.
