Prediction of Post-Resection Prognosis of HCC According to AFP-PIVKA-II (AP) Score as a Simplified Biomarker of ADV Score: A Validation Analysis Using Korea Liver Cancer Registry Database.

Background: A simplified prognostic model, the AFP-PIVKA-II (AP) score, was developed to predict outcomes after resection of hepatocellular carcinoma (HCC). Unlike the conventional ADV score, it relies only on serum biomarkers (AFP and PIVKA-II), excluding tumor size. Methods: This study included 2257 patients who underwent liver resection for HCC, using data from the Korea Liver Cancer Registry (2015-2022). The AP score's ability to predict overall survival (OS) and microvascular invasion (MVI) was evaluated and compared with radiologic and pathologic ADV scores. Results: Median preoperative AFP and PIVKA-II levels were 9.2 ng/mL and 62 mAU/mL. Increasing AP scores showed consistent association with worse OS (p < 0.001). Kaplan-Meier survival analyses using 1.0 log-, 2.0 log-, and 4.0 log-interval groupings consistently demonstrated a stepwise decline in OS with increasing AP score (all p < 0.001). At 4.0 log intervals, Harrell's c-indices for OS prediction were 0.604 (AP score), 0.681 (radiologic ADV score), and 0.677 (pathologic ADV score). For MVI prediction, the areas under the ROC curve values were 0.705, 0.733, and 0.741, respectively. Although ADV score-based models performed better overall, the AP score showed acceptable predictive ability for post-resection patient survival. Conclusion: The AP score is a simple, biomarker-based tool for estimating survival after HCC resection. While less accurate than ADV score models, its convenience supports use in settings requiring rapid assessment.