Hwang Shin, Song Gi-Won, Lee Young-Joo, Kim Ki-Hun, Ahn Chul-Soo, Moon Deok-Bog, Ha Tae-Yong, Jung Dong-Hwan, Park Gil-Chun, Lee Sung-Gyu
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
J Gastrointest Surg. 2016 Nov;20(11):1807-1820. doi: 10.1007/s11605-016-3187-y. Epub 2016 Jun 16.
We hypothesized that microvascular invasion (MVI) and post-resection prognosis in patients with solitary hepatocellular carcinoma (HCC) could be predicted using blood tumor markers and tumor volume (TV). We intended to identify a simple surrogate marker of HCC via a combination of clinical variables.
This retrospective study used the strictly selected development cohort (n = 1176) and validation cohort (n = 551) containing patients who underwent curative resection of solitary HCC.
In the development cohort study, the median values were 13.7 mL for TV, 24.2 ng/mL for α-fetoprotein (AFP), and 75 mAU/mL for des-γ-carboxy prothrombin (DCP); there was no correlation among these three factors (r ≤ 0.237, p < 0.001). The 1-, 3-, and 5-year rates were 22.4, 41.7, and 46.8 % for tumor recurrence and 93.6, 84.0, and 78.2 % for patient survival, respectively. Independent risk factors for both tumor recurrence and patient survival were tumor diameter >5 cm or TV >50 mL, MVI, satellite nodules, and high DCP. Multiplication of AFP, DCP, and TV (ADV score) resulted in prediction of MVI at a cutoff of 5log with sensitivity of 73.9 % and specificity of 66.7 %. Patient stratifications according to ADV score with cutoffs of 5log alone, 6log and 9log, and its combination with MVI showed significant prognostic differences (all p < 0.001). These prognostic significances were reliably reproduced in the validation cohort study (all p < 0.001).
We suggest that ADV score is an integrated surrogate marker of HCC prognosis. We believe that it can be used to predict MVI and post-resection prognosis for solitary HCC.
我们假设，通过血液肿瘤标志物和肿瘤体积（TV）可以预测孤立性肝细胞癌（HCC）患者的微血管侵犯（MVI）和切除术后预后。我们旨在通过结合临床变量来确定一种简单的HCC替代标志物。
这项回顾性研究使用了经过严格筛选的发展队列（n = 1176）和验证队列（n = 551），队列中的患者均接受了孤立性HCC的根治性切除术。
在发展队列研究中，TV的中位数为13.7 mL，甲胎蛋白（AFP）为24.2 ng/mL，异常凝血酶原（DCP）为75 mAU/mL；这三个因素之间无相关性（r≤0.237，p < 0.001）。肿瘤复发的1年、3年和5年发生率分别为22.4%、41.7%和46.8%，患者生存率分别为93.6%、84.0%和78.2%。肿瘤复发和患者生存的独立危险因素为肿瘤直径>5 cm或TV>50 mL、MVI、卫星结节和高DCP。AFP、DCP和TV的乘积（ADV评分）在截断值为5log时可预测MVI，敏感性为73.9%，特异性为66.7%。根据ADV评分进行的患者分层，截断值分别为单独的5log、6log和9log，以及与MVI联合分层，显示出显著的预后差异（所有p < 0.001）。这些预后意义在验证队列研究中得到可靠重现（所有p < 0.001）。
我们认为ADV评分是HCC预后的综合替代标志物。我们相信它可用于预测孤立性HCC的MVI和切除术后预后。
