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Quantitative Prognostic Prediction Using ADV Score for Hepatocellular Carcinoma Following Living Donor Liver Transplantation

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

We assessed the prognostic impact of the ADV score (α-fetoprotein [AFP]–des-γ-carboxyprothrombin [DCP]–tumor volume [TV] score) for predicting hepatocellular carcinoma (HCC) recurrence and patient survival after living donor liver transplantation (LDLT).

Methods

This study included 843 HCC patients who underwent LDLT between January 2006 and December 2015 at Asan Medical Center. These cases were divided into treatment-naïve (TN, n = 256]) and pretransplant-treated (PT, n = 587 [69.6%]) groups.

Results

There were weak or nearly no correlations among AFP, DCP, and TV. There existed high correlations between the pretransplant and explant findings regarding tumor number, size, and ADV score. Right lobe grafts were implanted in 760 (90.2%) patients. HCC recurrence and all-cause patient death occurred in 182 (15.9%) and 126 (15.0%) respectively during the follow-up period for 75.6 ± 35.5 months. The 5-year tumor recurrence (TR) and overall patient survival (OS) rates were 21.5% and 86.2%, respectively. The PT group showed higher TR (p < 0.001) and lower OS rates (p < 0.001). TR and OS were closely correlated with both pretransplant and explant ADV scores in the TN and PT groups. The ADV score enabled further prognostic stratification of the patients within and beyond the Milan, UCSF, and Asan Medical Center criteria. Compared with the 7 pre-existing selection criteria, ADV score with a cutoff of 5log showed the highest prognostic contrast regarding TR and OS.

Conclusions

Our prognostic prediction model using ADV scores is an integrated quantitative surrogate biomarker for posttransplant prognosis in HCC patients and can provide reliable information that assists the decision-making for LDLT.

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Abbreviations

AFP:

α-fetoprotein

DCP:

des-γ-carboxyprothrombin

TV:

Tumor volume

ADV score:

Multiplication of AFP, DCP, and TV

AD score:

Multiplication of AFP and DCP

AMC:

Asan Medical Center

HCC:

Hepatocellular carcinoma

LDLT:

Living donor liver transplantation

LT:

Liver transplantation

mRECIST:

Modified Response Evaluation Criteria In Solid Tumors

PT:

Pretransplant-treated

TN:

Treatment-naïve

UCSF:

University of California San Francisco

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Authors and Affiliations

  1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil 88, Songpa-gu, Seoul, 05505, Korea

    Shin Hwang, Gi-Won Song, Chul-Soo Ahn, Ki-Hun Kim, Deok-Bog Moon, Tae-Yong Ha, Dong-Hwan Jung, Gil-Chun Park, Young-In Yoon & Sung-Gyu Lee

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  1. Shin Hwang
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  2. Gi-Won Song
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  3. Chul-Soo Ahn
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  4. Ki-Hun Kim
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  5. Deok-Bog Moon
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  7. Dong-Hwan Jung
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  8. Gil-Chun Park
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  9. Young-In Yoon
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  10. Sung-Gyu Lee
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Correspondence to Shin Hwang.

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Hwang, S., Song, GW., Ahn, CS. et al. Quantitative Prognostic Prediction Using ADV Score for Hepatocellular Carcinoma Following Living Donor Liver Transplantation. J Gastrointest Surg 25, 2503–2515 (2021). https://doi.org/10.1007/s11605-021-04939-w

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  • DOI: https://doi.org/10.1007/s11605-021-04939-w

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