Lu Shang-Yu, Sun Han-Yao, Zhou Yan, Luo Xi, Liu Sheng, Zhou Wei-Zhong, Shi Hai-Bin, Yang Wei, Tian Wei
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
J Hepatocell Carcinoma. 2024 Oct 22;11:1979-1992. doi: 10.2147/JHC.S481393. eCollection 2024.
Hepatocellular carcinoma (HCC) represents a significant global health problem, requiring precise prognostic tools for optimal treatment stratification. This study aimed to develop a new risk prediction score, called AD score, based on the serum markers alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP), to offer an objective and accurate preoperative assessment of HCC in patients undergoing transarterial chemoembolization (TACE).
This was a retrospective study that included 295 HCC patients who were subjected to TACE (training set, n=147; testing set, n=148). Serum AFP and DCP levels were log-transformed to construct the AD score. Multivariate Cox regression analysis on cirrhosis subgroups validated the objectivity of the model. Performance comparison of established models (Child Pugh, BCLC, ALBI, Up-to-seven, Six-and-twelve, Four and seven, HAP score, mHAP-II, FAIL-T score), was assessed through time-dependent receiver operating characteristic (ROC) curves and risk stratification.
The AD score, incorporating lgAFP and lgDCP, demonstrated superior predictive accuracy than the existing models. Time-dependent ROC curve revealed the consistent superiority of the AD score over a 5-year period. The risk stratification into low, intermediate, and high group based on the AD score showed a significant survival difference in both training and testing set.
For HCC patients undergoing TACE, the AD score serves as an objective and straightforward prognostic tool, enhancing predictive accuracy and showcasing its clinical utility. It demonstrates potential significance as a crucial addition to preoperative risk assessment for TACE.
肝细胞癌（HCC）是一个重大的全球健康问题，需要精确的预后工具来实现最佳治疗分层。本研究旨在基于血清标志物甲胎蛋白（AFP）和异常凝血酶原（DCP）开发一种新的风险预测评分，即AD评分，以对接受经动脉化疗栓塞术（TACE）的HCC患者进行客观、准确的术前评估。
这是一项回顾性研究，纳入了295例接受TACE的HCC患者（训练集，n = 147；测试集，n = 148）。对血清AFP和DCP水平进行对数转换以构建AD评分。对肝硬化亚组进行多变量Cox回归分析，验证了该模型的客观性。通过时间依赖性受试者工作特征（ROC）曲线和风险分层评估已建立模型（Child Pugh、BCLC、ALBI、Up-to-seven、Six-and-twelve、Four and seven、HAP评分、mHAP-II、FAIL-T评分）的性能比较。
包含lgAFP和lgDCP的AD评分显示出比现有模型更高的预测准确性。时间依赖性ROC曲线显示AD评分在5年期间始终具有优越性。基于AD评分将风险分为低、中、高组，在训练集和测试集中均显示出显著的生存差异。
对于接受TACE的HCC患者，AD评分是一种客观、简便的预后工具，提高了预测准确性并展示了其临床实用性。它作为TACE术前风险评估的重要补充具有潜在意义。
