AFP-PIVKA-II score as a simplified quantifiable surrogate biomarker for hepatocellular carcinoma recurrence following living donor liver transplantation
- Author:
Dae Hyeon WON
1
;
Shin HWANG
;
Chul-Soo AHN
;
Deok-Bog MOON
;
Tae-Yong HA
;
Gi-Won SONG
;
Dong-Hwan JUNG
;
Gil-Chun PARK
;
Woo-Hyoung KANG
;
Young-In YOON
;
Sung-Gyu LEE
Author Information
- Publication Type:Original Article
- From: Annals of Liver Transplantation 2026;6(1):25-32
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:We developed a simplified variant of the ADV score, the AFP-PIVKAII (AP) score for post-transplant hepatocellular carcinoma (HCC) prognosis, which considers only AFP and PIVKA-II levels excluding morphometric tumor size information from the ADV score. This study investigated the prognostic performance of the AP score in predicting HCC recurrence and overall survival (OS) after living donor liver transplantation (LDLT).
Methods:We analyzed 843 patients with HCC who underwent LDLT between 2006 and 2015, assessing HCC recurrence and OS in relation to AP score.
Results:The median pretransplant AFP and PIVKA-II levels were 12.8 ng/mL and 27 mAU/mL, respectively. The median and mean AP scores were 2.6 log (range: 0.6–9.2 log) and 2.9±1.1 log, respectively. The 5-year time-dependent area under the receiver operating characteristic curve for the AP score in predicting post-transplant HCC recurrence was 0.672 (p<0.001). HCC recurrence and OS curves along AP score intervals of 1.0 log showed statistical differences in accordance with the AP scores (both p<0.001). Using a Youden index J-derived AP score cutoff of 4.0 log, two-tiered groups (ADV <4.0 log vs. ADV ≥4.0 log) showed statistically significant differences in HCC recurrence and OS (both p<0.001). Harrell’s c-indices for AP score with cutoff of 4.0 log and ADV scores with cutoff of 5.0 log regarding HCC recurrence and OS were similar.
Conclusion:The AP score functions as an integrated surrogate marker for predicting post-transplant outcomes in patients with HCC undergoing LDLT. It may serve as a simplified alternative to the ADV score, particularly in patients with small HCCs.
