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Enhancing Recurrence-Free Survival Prediction in Hepatocellular Carcinoma: A Time-Updated Model Incorporating Tumor Burden and AFP Dynamics.

2025-08Text Open access
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dc.contributor.authorAkabane, Miho
dc.contributor.authorKawashima, Jun
dc.contributor.authorAltaf, Abdullah
dc.contributor.authorWoldesenbet, Selamawit
dc.contributor.authorCauchy, François
dc.contributor.authorAucejo, Federico
dc.contributor.authorPopescu, Irinel
dc.contributor.authorKitago, Minoru
dc.contributor.authorMartel, Guillaume
dc.contributor.authorRatti, Francesca
dc.contributor.authorAldrighetti, Luca
dc.contributor.authorPoultsides, George A
dc.contributor.authorImaoka, Yuki
dc.contributor.authorRuzzenente, Andrea
dc.contributor.authorEndo, Itaru
dc.contributor.authorGleisner, Ana
dc.contributor.authorPinto Marques, Hugo
dc.contributor.authorOliveira, Sara
dc.contributor.authorBalaia, Jorge
dc.contributor.authorLam, Vincent
dc.contributor.authorHugh, Tom
dc.contributor.authorBhimani, Nazim
dc.contributor.authorShen, Feng
dc.contributor.authorPawlik, Timothy M
dc.date.accessioned2025-08-28T13:44:50Z
dc.date.available2025-08-28T13:44:50Z
dc.date.issued2025-08
dc.description.abstractBackground: Existing models to predict recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on static preoperative factors such as alpha-fetoprotein (AFP) and tumor burden score (TBS). These models overlook dynamic postoperative AFP changes, which may reflect evolving recurrence risk. We sought to develop a dynamic, real-time model integrating time-updated AFP values with TBS for improved recurrence prediction. Patients and methods: Patients undergoing curative-intent hepatectomy for HCC (2000-2023) were identified from an international, multi-institutional database with RFS as the primary outcome. AFP trajectory was monitored from preoperative to 6- and 12-month postoperative values, using time-varying Cox regression with AFP as a time-dependent covariate. The predictive accuracy of this time-updated model was compared with a static preoperative Cox model excluding postoperative AFP. Results: Among 1911 patients, AFP trajectories differed between recurrent and nonrecurrent cases. While preoperative AFP values were similar, recurrent cases exhibited higher AFP at 6 and 12 months. Multivariable analysis identified TBS (hazard ratio (HR):1.043 [95% confidence interval (CI): 1.002-1.086]; p = 0.039) and postoperative log AFP dynamics (HR:1.216 [CI 1.132-1.305]; p < 0.001) as predictors. Contour plots depicted TBS's influence decreasing over time, while postoperative AFP became more predictive. The time-varying Cox model was created to update RFS predictions continuously on the basis of the latest AFP values. The preoperative Cox model, developed with age, AFP, TBS, and albumin-bilirubin score, had a baseline C-index of 0.61 [0.59-0.63]. At 6 months, the time-varying model's C-index was 0.70 [0.67-0.73] versus 0.59 [0.56-0.61] for the static model; at 12 months, it was 0.70 [0.66-0.73] versus 0.56 [0.53-0.59]. The model was made available online ( https://nm49jf-miho-akabane.shinyapps.io/AFPHCC/ ). Conclusions: Incorporating postoperative AFP dynamics into RFS prediction after HCC resection enhanced prediction accuracy over time, as TBS's influence decreased. This adaptive, time-varying model provides refined RFS predictions throughout follow-up.eng
dc.identifier.citationAnn Surg Oncol . 2025 Aug;32(8):5648-5656. doi: 10.1245/s10434-025-17303-y.
dc.identifier.doi10.1245/s10434-025-17303-y.
dc.identifier.pmid40238062
dc.identifier.urihttp://hdl.handle.net/10400.17/5157
dc.language.isoeng
dc.peerreviewedyes
dc.publisherSpringer
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectHCC CIR
dc.subjectAged
dc.subjectFemale
dc.subjectMale
dc.subjectHumans
dc.subjectMiddle Aged
dc.subjectBiomarkers
dc.subjectTumor*
dc.subjectCarcinoma
dc.subjectHepatocellular* / blood
dc.subjectHepatocellular* / mortality
dc.subjectHepatocellular* / pathology
dc.subjectHepatocellular* / surgery
dc.subjectFollow-Up Studies
dc.subjectHepatectomy* / mortality
dc.subjectLiver Neoplasms* / blood
dc.subjectLiver Neoplasms* / mortality
dc.subjectLiver Neoplasms* / pathology
dc.subjectLiver Neoplasms* / surgery
dc.subjectNeoplasm Recurrence
dc.subjectLocal* / blood
dc.subjectLocal* / metabolism
dc.subjectLocal* / mortality
dc.subjectLocal* / pathology
dc.subjectLocal* / surgery
dc.subjectRetrospective Studies
dc.subjectPrognosis
dc.subjectSurvival Rate
dc.subjectTumor Burden
dc.subjectalpha-Fetoproteins* / metabolism
dc.titleEnhancing Recurrence-Free Survival Prediction in Hepatocellular Carcinoma: A Time-Updated Model Incorporating Tumor Burden and AFP Dynamics.eng
dc.typetext
dspace.entity.typePublication
oaire.citation.endPage5656
oaire.citation.issue8
oaire.citation.startPage5648
oaire.citation.titleAnnals of Surgical Oncology
oaire.citation.volume32
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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