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 HCCs ≥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.
Citations
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Five-year complete remission of super-giant hepatocellular carcinoma with hepatectomy followed by sorafenib plus camrelizumab: A case report Xiao-Qin Zheng, Li-Bo Sun, Wen-Jie Jin, Hui Liu, Wen-Yan Song, Hui Xu, Ju-Shan Wu, Xiao-Jun Wang, Chun-Yan Gou, Hui-Guo Ding World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Early identification of hepatocellular carcinoma patients at high-risk of recurrence using the ADV score: a multicenter retrospective study Shuya Cao, Zheyu Zhou, Chaobo Chen, Wenwen Li, Jinsong Liu, Jiawei Xu, Chunlong Zhao, Yihang Yuan, Zhenggang Xu, Huaiyu Wu, Guwei Ji, Xiaoliang Xu, Ke Wang World Journal of Surgical Oncology.2024;[Epub] CrossRef
ADV score is a reliable surrogate biomarker of hepatocellular carcinoma in liver resection and transplantation Shin Hwang, Dong-Hwan Jung, Gi-Won Song Annals of Liver Transplantation.2023; 3(2): 86. CrossRef
Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide, especially in Asian countriesas well as
Korea, and liver transplantation (LT) has potentials to improve survival for patients with HCC. However, major hamper to LT for
HCC has been graft shortage. To solve this problem, liver resection (LR) has to be rejuvenated in the general algorithm of HCC
treatment in the light of salvage transplantation (ST) strategies. The LR followed by ST in case of HCC recurrence is an attractive
concept in early stage HCC and cirrhosis with acceptable liver function. These challenges in technique, indications, pre-LT
observation and treatments for recurred HCC, and prioritization policies of patients on the waiting list have to be precise through
prospective investigations that have to include individualization of prognosis, biological variables and pathology surrogates as
stratification criteria. Accepting this challenges have been part of the history of LT and will endure for the future. This article will
focus on the ST after LR in terms of intention-to-analysis
Hepatocellular carcinoma (HCC) surveillance programs have led to an increase in the adoption of radical therapies.
Nevertheless, HCCs often present at an advanced stage and the prognosis remains dismal even after resection due to the high rate
of recurrence. The study of tumor biology is important to predict clinical outcome enabling more appropriate therapeutic decisions
for HCC patients. Understanding molecular mechanisms of hepatocarcinogenesis may also lead to effective strategies in
chemoprevention. However, current staging systems based on clinicopathologic factors are limited in prognostic prediction.
Recently, there has been great interest in the study of gene expression profile in relation to prognosis of HCC. Global gene
expression profiling may be the most appropriate technology to unravel the pathogenesis of HCC and explore its heterogeneous
origin. The elucidation of tumor biology of HCC is of paramount clinical importance in the new era of molecular target therapy.