Development and validation of six-parameter laboratory-based prognostic model (APHPBA score) for patients undergoing...

HBV-related HCC shows prognostic heterogeneity not fully captured by current staging. We developed and validated the APHPBA score, a laboratory-based model for patients undergoing curative hepatectomy.

This multicenter retrospective study included patients who underwent hepatectomy for HBV-related HCC between 2018 and 2023. The APHPBA score incorporated six routine preoperative parameters: alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), HBV-DNA, prothrombin time (PT), bilirubin (BIL), and albumin (ALB). Patients were stratified into three stages: Stage I (0-1 point), Stage II (2-3 points), and Stage III (4-6 points). Prognostic performance was compared with conventional systems using Cox regression and time-dependent receiver operating characteristic (ROC) analyses.

Among 1100 patients, 36.7 % were Stage I, 48.5 % Stage II, and 14.8 % Stage III. After a median follow-up of 48.0 months, 5-year overall survival was 63.4 %, 43.3 %, and 26.4 % across Stages I-III (P < 0.001). The APHPBA score remained independently associated with overall survival after adjustment for clinicopathologic factors and consistently outperformed established staging systems with higher time-dependent AUCs.

The APHPBA score provides robust postoperative risk stratification for HBV-related HCC using routinely available laboratory parameters.