간세포암 절제에서 ADV score가 가지는 예후 평가의 효용성 입증

Abstract

Background: We aimed to validate the prognostic power 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 hepatocellular carcinoma (HCC) resection. Methods: This study included 1390 patients with HCC registered in the Korea Liver Cancer Registry. Patients underwent hepatic resection between 2008 and 2012 and were followed up until December 2016. They were divided into 4 groups according to the number of tumors and preoperative treatment. Results: There was no significant correlation among AFP, DCP, and TV values (r2≤0.04, p<0.001). In group 1 with single naïve tumor (n=1154), patient stratification with ADV 1log-interval and cutoffs of 5log, 7log, and 10log showed great prognostic contrast (p<0.001). In group 2 with multiple naïve tumors (n=170), patient stratification with ADV 1log-interval and above-mentioned 3 cutoffs also showed great prognostic contrast (p<0.001). In group 3 (n=50) and group 4 (n=16) with pretreated tumors, patient stratification with ADV 1log-interval and above-mentioned 3 cutoffs showed a noticeable prognostic contrast (p≤0.031). The ADV score based on preoperative findings also showed great prognostic contrast in 1106 patients preoperatively diagnosed as having single naïve tumor (p<0.001). Confining patients to tumor-node-metastasis stage I and II (n=1072) as well as Barcelona Clinic Liver Cancer stage 0 and A (n=862), ADV cutoffs showed further prognostic stratification. 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 expanded to those with multiple or pretreated HCCs.