Korean J Transplant.  2022 Nov;36(Supple 1):S33. 10.4285/ATW2022.F-1312.

Analysis of posttransplant hepatocellular carcinoma prognosis using ADV score: a validation multicenter study

• Hwang S
• Park GC
• You YK
• Choi Y
• Kim JM
• Joo DJ
• Ryu JH
• Choi D
• Kim BW
• Kim DS

• KMID: 2535205
• DOI: http://doi.org/10.4285/ATW2022.F-1312

Abstract

Background
ADV score (α-fetoprotein [AFP]–des-γ-carboxyprothrombin [DCP]–tumor volume [TV] score) has been reported as a prognostic surrogate biomarker of hepatocellular carcinoma (HCC) following liver transplantation (LT) and hepatectomy. This study aimed to validate the prognostic impact of ADV score for analyzing prognosis of HCC following LT.
Methods
The study patients were 1,599 LT recipients selected from Korean Organ Transplantation Registry database.
Results
Deceased-donor and living-donor LTs were performed in 143 and 1,456 cases, respectively. Weak correlation was present among AFP, DCP and TV. The viable HCC group showed ADV score-dependent disease-free survival (DFS) and overall patient survival (OS) rates from 1log to 10log (P<0.001). Prognosis of complete pathological response group was comparable to that of ADV score <1log (P≥0.099). ADV score cutoff of 5log (ADV-5log) for DFS and OS was obtained through receiver operating characteristic curve analysis with area under the curve ≥0.705. Both ADV-5log and Milan criteria were independent risk factors for DFS and OS, and their prognostic impacts were comparable each other. Combination of these two factors resulted in further prognostic stratification, showing hazard ratios for DFS and OS as 2.98 and 2.26 respectively for one risk factor and 7.92 and 8.19 respectively for two risk factors (P<0.001). ABO-incompatible recipients with ADV score ≥8log or two risk factors showed higher recurrence rates.
Conclusions
This multicenter validation study revealed that ADV score is a reliable surrogate biomarker for posttransplant HCC prognosis, which can be used for selecting LT candidates and guiding risk-based posttransplant follow-up surveillance.