Prognostic Accuracy of the ADV Score Following Resection of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Abstract

Background WeassessedtheprognosticaccuracyofADVscore(α-fetoprotein[AFP]-des-γ-carboxyprothrombin[DCP]-tumor volume [TV] score) following resection of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods This was a retrospective observational study. This study included 147 patients who underwent hepatic resection for HCC with PVTT. They were followed up for ≥ 66 months or until patient death. Results The grades of PVTT were Vp1 in 121 (14.3%), Vp2 in 41 (27.9%), Vp3 in 71 (48.3%), and Vp4 in14 (9.5%) cases. PreoperativeHCCtreatmentwasperformedin48(32.7%)patients.R0andR1resectionswereperformedin119(81.0%)and28 (19.0%)cases,respectively.The5-yeartumorrecurrence,HCC-specificsurvival,andpost-recurrencesurvivalrateswere79.2%, 43.5%, and 25.4%, respectively. Neither PVTT grade nor history of preoperative HCC treatment was a significant prognostic indicator. Stratification in accordance with ADV scores of 1log- and 3log-intervals resulted in high prognostic accuracy in predicting tumor recurrence and patient survival. Following cluster analysis, the cutoff for ADV score was determined at 9log and was more prognostically significant in terms of tumor recurrence and patient survival than surgical curability or microvascularinvasion.FurthercomparisonsrevealedthatprognosticpredictionwithanADVscorecutoffat9logwasmoreaccuratethan that using the Eastern Hepatobiliary Surgery Hospital-PVTT score. Conclusions ADV score is an integrated surrogate biomarker for post-resection prognosis in HCC with PVTT. Our prognostic prediction model using ADV scores provides reliable post-resection prognosis for patients with various grades of these tumors.