European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Preoperative ASAP score predicts recurrence and survival following curative hepatic resection for hepatitis B virus-related hepatocellular carcinoma: A multicenter cohort study.
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Yin Dongxu, Wang Zixuan, Li Chao, Fan Huixuan, Tu Zichao, Diao Yongkang, Tang Zijie, Zeng Yongyi, Wu Han, Gu Lihui, Yao Lanqing, Xu Xinfei, Shen Feng, Wang Mingda, Yang Tian
Аннотация
BACKGROUND & AIMS: The ASAP score, integrating age, sex, alpha-fetoprotein (AFP), and protein induced by vitamin K absence or antagonist-II (PIVKA-II), has demonstrated value for early detection of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection. This study sought to assess whether the ASAP score could also predict recurrence and survival following curative resection of HBV-related HCC.
METHODS: This multicenter study included patients undergoing curative hepatic resection for HBV-related HCC. The ASAP score was calculated preoperatively. The primary endpoints were time-to-recurrence (TTR) and overall survival (OS). The optimal ASAP cutoff was identified using X-tile analysis. Multivariate Cox regression model was used to evaluate the independent prognostic significance of the ASAP score.
RESULTS: In total, 752 patients were analyzed. The optimal cutoff value for preoperative ASAP was 4.8. Patients in the high ASAP group (≥4.8) had significantly higher recurrence rates (5-year: 73.4 % vs. 52.1 %, P < 0.001) and poorer survival outcomes (5-year OS: 30.7 % vs. 58.1 %, P < 0.001) compared with those in the low ASAP group (<4.8). On multivariate Cox regression analysis, a high ASAP score remained independently predictive of TTR (HR 1.264; 95 % CI 1.010-1.582; P = 0.031) and OS (HR 1.266; 95 % CI 1.017-1.608; P = 0.033). Moreover, the ASAP score exhibited good predictive performance for both TTR and OS.
CONCLUSIONS: Preoperative ASAP score independently predicts recurrence and survival outcomes in patients undergoing curative resection for HBV-related HCC. Given its simplicity and accessibility, the ASAP score may facilitate individualized postoperative surveillance and improved risk stratification for these patients.
METHODS: This multicenter study included patients undergoing curative hepatic resection for HBV-related HCC. The ASAP score was calculated preoperatively. The primary endpoints were time-to-recurrence (TTR) and overall survival (OS). The optimal ASAP cutoff was identified using X-tile analysis. Multivariate Cox regression model was used to evaluate the independent prognostic significance of the ASAP score.
RESULTS: In total, 752 patients were analyzed. The optimal cutoff value for preoperative ASAP was 4.8. Patients in the high ASAP group (≥4.8) had significantly higher recurrence rates (5-year: 73.4 % vs. 52.1 %, P < 0.001) and poorer survival outcomes (5-year OS: 30.7 % vs. 58.1 %, P < 0.001) compared with those in the low ASAP group (<4.8). On multivariate Cox regression analysis, a high ASAP score remained independently predictive of TTR (HR 1.264; 95 % CI 1.010-1.582; P = 0.031) and OS (HR 1.266; 95 % CI 1.017-1.608; P = 0.033). Moreover, the ASAP score exhibited good predictive performance for both TTR and OS.
CONCLUSIONS: Preoperative ASAP score independently predicts recurrence and survival outcomes in patients undergoing curative resection for HBV-related HCC. Given its simplicity and accessibility, the ASAP score may facilitate individualized postoperative surveillance and improved risk stratification for these patients.