Identifying a biologically high-risk subgroup of anatomically resectable hepatocellular carcinoma

期刊论文
发表日期：

2026年6月12日

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Kazunari Tanaka,
Kunihiko Tsuji,
Atsushi Hiraoka,
Toshifumi Tada,
Kazuya Kariyama,
Ei Itobayashi,
Toru Ishikawa,
Hidenori Toyoda,
Yuichi Koshiyama,
Takeshi Hatanaka,
Satoru Kakizaki,
Atsushi Naganuma,
Tomomitsu Matono,
Yoshihide Ueda,
Hironori Tanaka,
Jumpei Okamura,
Hideyuki Tamai,
Kenji Kuwaki,
Fujimasa Tada,
Hideko Ohama,
Yuki Kanayama,
Kazuhiro Nouso,
Michitaka Imai,
Shinichiro Nakamura,
Soo Ki Kim,
Takashi Kumada

摘要

Background & Aims

Although anatomically resectable hepatocellular carcinoma (HCC) is generally treated with surgery alone, a substantial proportion of patients experience early recurrence, suggesting underlying biological aggressiveness. We aimed to identify a biologically high-risk subgroup among anatomically resectable HCCs and to develop a simple preoperative biology-based risk score.

Methods

In this multicenter retrospective cohort study, patients who underwent curative-intent hepatectomy for anatomically resectable HCC were temporally divided into training and validation cohorts. Early recurrence was defined as recurrence within 2 years after surgery. Independent predictors were identified using multivariable logistic regression and incorporated into a risk score. Predictive performance was assessed by recurrence-free survival (RFS), AUC, Akaike information criterion, and calibration analysis.

Results

Alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and the fibrosis-related host factor FIB-3 were independently associated with early recurrence and were integrated into the ADF (AFP, DCP and FIB-3) score (range, 0‐3). In the validation cohort, higher ADF scores were associated with progressively worse RFS (p < 0.001). The ADF score outperformed each individual component alone, showed good calibration, and the addition of tumor size improved discrimination.

Conclusions

The ADF score identifies a biologically high-risk subgroup within anatomically resectable HCC that is prone to early postoperative recurrence. This biology-based framework may complement anatomical assessment and help refine preoperative risk stratification.