Tumour Biology Characteristics Score Based on AFP and PIVKA-II Predicts Recurrence and Survival After Curative Resection for Hepatocellular Carcinoma: A Multicentre Cohort Study.

Abstract

Background: Current hepatocellular carcinoma (HCC) staging systems lack comprehensive assessment of tumour biological characteristics. This study aimed to develop and validate a tumour biology characteristics score (TBCS) based on alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) to predict long-term oncologic outcomes after HCC resection.

Methods: In this multicentre retrospective cohort study, patients who underwent curative resection for HCC between June 2018 and December 2022 were included. TBCS (range 2-6 points) was calculated by combining preoperative AFP (<20, 20~199, ≥200ng/mL) and PIVKA-II (<40, 40~399, ≥400 mAU/mL) levels. Patients were stratified into low (2 points), medium (3~4 points), and high (5~6 points) TBCS groups. The primary outcomes were recurrence-free survival (RFS) and overall survival (OS).

Results: A total of 695 patients were analysed; the low, medium, and high TBCS groups comprised 132 (19.0%), 233 (33.5%), and 330 (47.5%) patients, respectively. 5-year RFS was 30.4%, 14.7%, and 9.7%, while 5-year OS was 42.1%, 35.5%, and 23.5% for low, medium, and high TBCS groups, respectively (both P<0.001). Multivariate analysis identified TBCS as an independent predictor of both RFS (medium TBCS: HR 1.583, 95% CI 1.219-2.057, P=0.001; high TBCS: HR 1.895, 95% CI 1.473-2.438, P<0.001) and OS (high TBCS: HR 1.781, 95% CI 1.353-2.343, P<0.001).

Conclusions: The novel TBCS combining AFP and PIVKA-II effectively stratified HCC patients into distinct prognostic groups after curative-intent resection, independently predicting both RFS and OS. This score may help identify high-risk patients for more intense postoperative recurrence surveillance, as well as receipt of adjuvant therapies.