Introduction : We aimed to assess the prognostic accuracy of ADV score (alpha-fetoprotein [AFP]-des-γ-carboxyprothrombin [DCP]-tumor volume [TV] score, calculated as AFP [ng/mL] x DCP [mAU/mL] x TV [mL]) for predicting postoperative prognosis after resection of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).

Methods : This retrospective study included 147 patients who underwent hepatic resection for HCC with PVTT.

Results : Grades of PVTT were Vp1 in 121 (14.3%), Vp2 in 41 (27.9%), Vp3 in 71 (48.3%), and Vp4 in14 (9.5%). Preoperative HCC treatment was performed in 48 (32.7%). R0 and R1 resections were performed in 119 (81.0%) and 28 (19.0%), respectively. Five-year tumor recurrence, HCC-specific survival and post-recurrence survival rates were 79.2%, 43.5% and 25.4%, respectively. Grades of PVTT and history of preoperative HCC treatment were not significant prognostic factors. Stratification according to ADV scores of 1log and 3log intervals resulted in high prognostic contrast in tumor recurrence and patient survival. After cluster analysis, the cutoff for ADV score was determined at 9log, which was more significantly prognostic in tumor recurrence and patient survival than surgical curability and microvascular invasion. Comparison with Eastern Hepatobiliary Surgery Hospital (EHBH)-PVTT scoring system resulted that prognostic prediction with ADV score with cutoff at 9log was more accurate than that of EHBH-PVTT score.

Conclusions : ADV score is an integrated surrogate biomarker for post-resection prognosis in patients having HCC with PVTT. We believe that our prognostic prediction model using ADV scores can provide reliable information to help predicting the post-resection prognosis in patients having HCC with PVTT of various grades.