Preoperative ASAP score predicts recurrence and survival following curative hepatic resection for hepatitis B virus-related hepatocellular carcinoma: A multicenter cohort study.

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.