Korean J Transplant.  2022 Nov;36(Supple 1):S33. 10.4285/ATW2022.F-1312.

Analysis of posttransplant hepatocellular carcinoma prognosis using ADV score: a validation multicenter study

  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Surgery, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea
  • 3Department of Surgery, Seoul National University Hospital, Seoul, Korea
  • 4Department of Surgery, Samsung Medical Center, Seoul, Korea
  • 5Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 6Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
  • 7Department of Surgery, Daegu Catholic University Medical Center, Daegu, Korea
  • 8Department of Surgery, Ajou University Hospital, Suwon, Korea
  • 9Department of Surgery, Korea University Anam Hospital, Seoul, Korea


ADV score (α-fetoprotein [AFP]–des-γ-carboxyprothrombin [DCP]–tumor volume [TV] score) has been reported as a prognostic surrogate biomarker of hepatocellular carcinoma (HCC) following liver transplantation (LT) and hepatectomy. This study aimed to validate the prognostic impact of ADV score for analyzing prognosis of HCC following LT.
The study patients were 1,599 LT recipients selected from Korean Organ Transplantation Registry database.
Deceased-donor and living-donor LTs were performed in 143 and 1,456 cases, respectively. Weak correlation was present among AFP, DCP and TV. The viable HCC group showed ADV score-dependent disease-free survival (DFS) and overall patient survival (OS) rates from 1log to 10log (P<0.001). Prognosis of complete pathological response group was comparable to that of ADV score <1log (P≥0.099). ADV score cutoff of 5log (ADV-5log) for DFS and OS was obtained through receiver operating characteristic curve analysis with area under the curve ≥0.705. Both ADV-5log and Milan criteria were independent risk factors for DFS and OS, and their prognostic impacts were comparable each other. Combination of these two factors resulted in further prognostic stratification, showing hazard ratios for DFS and OS as 2.98 and 2.26 respectively for one risk factor and 7.92 and 8.19 respectively for two risk factors (P<0.001). ABO-incompatible recipients with ADV score ≥8log or two risk factors showed higher recurrence rates.
This multicenter validation study revealed that ADV score is a reliable surrogate biomarker for posttransplant HCC prognosis, which can be used for selecting LT candidates and guiding risk-based posttransplant follow-up surveillance.

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