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A novel model integrating aMAP score and tumor size predicts survival in hepatitis B -associated hepatocellular carcinoma

evidence-based-medicine
gastroenterology-and-hepatology
oncology

Abstract

Background . The aMAP (age-Male-Albumin-Bilirubin-Platelets) score has recently emerged as a robust tool for stratifying the risk of hepatocellular carcinoma (HCC) development in at-risk populations. However, its utility in predicting postoperative prognosis for patients with established HCC remains less defined. This study aimed to comprehensively evaluate the prognostic performance of the aMAP score in patients undergoing radical resection for hepatitis B virus (HBV)-associated HCC.
Methods . We conducted a retrospective analysis of 471 patients with HBV-associated HCC who underwent curative resection. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Survival analyses were performed using the Kaplan-Meier method with log-rank tests. Independent prognostic factors were identified via multivariate Cox regression. The predictive accuracy of the aMAP score was compared against the established Albumin-Bilirubin (ALBI) and Platelet-Albumin-Bilirubin (PALBI) scores using the concordan c e index (C-index).
Results . A high aMAP score was significantly associated with poorer OS and RFS. Multivariate analysis confirmed that the aMAP score, along with aspartate transaminase (AST) level, platelet count, and tumor size, served as an independent prognostic factor for both endpoints. In comparative analyses, the aMAP score demonstrated superior discriminative ability (higher C-index) for survival outcomes than both the ALBI and PALBI scores. Furthermore, integrating the aMAP score with tumor size yielded a composite model (C-index = 0.747) thatoutperformed the aMAP score alone. Based on this combination, we stratified patients into three distinct prognostic stages (Stage I, II, and III). This novel staging system effectively differentiated clinical outcomes, with Stage I patients exhibiting significantly superior OS and RFS compared to those in Stages II and III.
Conclusions . The aMAP score is a powerful and independent prognostic predictor for patients with HBV-associated HCC after radical resection. Its predictive efficacy is enhanced when combined with tumor size, forming a simple yet effective staging system that can aid in postoperative risk stratification and informpersonalized management strategies.
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