Usefulness of aMAP Risk Score for Predicting Recurrence after Curative Treatment for Hepatocellular Carcinoma within Milan Criteria

Abstract

<b><i>Introduction:</i></b> The aMAP score is a prediction model for hepatocellular carcinoma (HCC) risk in chronic hepatitis patients. This study was conducted to elucidate the utility of this model for predicting initial recurrence of HCC in patients within the Milan criteria after undergoing curative treatment. <b><i>Methods:</i></b> Patients with naïve HCC within the Milan criteria (<i>n</i> = 1,020) and treated from January 2000 to August 2022 were enrolled. The cohort was divided into two groups according to the aMAP score (high ≥60, low &lt;60) and then compared for recurrence-free survival (RFS) and overall survival (OS). <b><i>Results:</i></b> Comparisons between the high and low groups showed that etiology (HBV:HCV:HBV+HCV:NBNC = 41:79:2:37 vs. 65:589:11:196, <i>p</i> &lt; 0.001), AST (36 vs. 46 IU/L, <i>p</i> &lt; 0.001), and multiple HCC occurrence (15% vs. 22%, <i>p</i> = 0.026) were significantly different. Additionally, median RFS (59.8 vs. 30.9 months; <i>p</i> &lt; 0.001) and median OS (154.1 vs. 83.4 months, <i>p</i> &lt; 0.01) were greater in the low group. As for patients with HCC due to chronic viral hepatitis, there was a significant difference in median RFS between the groups (59.8 vs. 30.6 months, <i>p</i> &lt; 0.001), especially for HCV-positive patients (53.1 vs. 27.2 months, <i>p</i> = 0.002). In patients with HCC due to a nonviral cause, the difference in median RFS between the low (70.9 months) and high (32.0 months) groups was not significant. <b><i>Discussion:</i></b> Findings of this retrospective study indicate a significant association of elevated aMAP with worse RFS in patients with HCC caused by chronic viral hepatitis, especially those with HCV. The aMAP score is considered useful to predict not only HCC-carcinogenesis risk but also risk of recurrence following curative treatment.