Prediction of post-resection prognosis with ADV score for huge hepatocellular carcinoma ≥ 13 cm

Abstract

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). The objective of this study was to validate the predictive power of ADV score-based prognostic prediction model for patients with solitary huge HCC. Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥ 13 cm during the study period between 2008 and 2012 were selected. 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 1 year, and 84.9% and 34.0% at 5 years, respectively. Microvascular invasion was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS stratified by ADV score with 1log intervals showed significant prognostic contrasts (p = 0.007 and p = 0.017, respectively). DFS and OS stratified by ADV score with a cutoff of 8log showed significant prognostic contrasts (p = 0.014 and p = 0.042, respectively). Combination of MVI and ADV score with a cutoff of 8log also showed significant prognostic contrasts in DFS (p < 0.001) and OS (p = 0.001) according to the number of risk factors. The prognostic prediction model with ADV score with or without combination of MVI could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCCs ≥ 13 cm. 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.