J Liver Cancer.  2021 Mar;21(1):45-57. 10.17998/jlc.21.1.45.

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

• Hwang S
• Kim KH
• Moon DB
• Ahn CS
• Ha TY
• Song GW
• Jung DH
• Park GC

• KMID: 2514234
• DOI: http://doi.org/10.17998/jlc.21.1.45

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.

Keyword

Hepatocellular carcinoma; Resection; Recurrence; Microvascular invasion; Tumor biology

Figure

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  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).

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  Figure 2 Kaplan-Meier estimation of post-resection tumor recurrence (A) and overall patient survival (B).

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  Figure 3 Comparison of the disease-free survival (A) and overall survival (B) curves according to the status of microvascular invasion (MVI).

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  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.

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  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.

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  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).

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