ASAP score predicts early HCC recurrence after complete radiological response to locoregional treatments

BACKGROUND AND AIMS: The ASAP algorithm incorporating Age, Sex, Alpha-fetoprotein (AFP), and prothrombin induced by vitamin K absence/antagonist II (PIVKA-II) has been shown to predict hepatocellular carcinoma (HCC) development. Our study evaluated the prognostic value of ASAP for early HCC recurrence after complete radiological response (CR) to locoregional therapy. METHODS: This single-center study enrolled patients with newly diagnosed HCC who achieved CR by ablation (MWTA) or chemoembolization (TACE) and available serum samples on the day of treatment. CR was evaluated by CT-scan 1 month after treatment. PIVKA-II and AFP levels were measured using Fujirebio assays. Patients were followed up every three months until recurrence, death, or last follow-up. RESULTS: 127 patients with HCC (median age 66 years, 79 % male, 79 % with viral etiology) who achieved CR were enrolled. At time of treatment, median AFP and PIVKA-II levels were 6.6 ng/mL and 144 mAU/mL, respectively, while median ASAP score was 0.60. During follow-up, HCC recurred in 72 (56.7 %) patients (63 within 24 months, early recurrence). ASAP score was the sole independent predictor of early recurrence [HR 2.57 (95 % CI 1.50-4.40), p=0.001] and its new cutoff of 0.797 (AUC 66 %, sensitivity 57 %, specificity 75 %) outperformed other scores and biomarkers. CONCLUSIONS: The ASAP score accurately predicted early HCC recurrence post-CR, warranting further validation.