Prognostic Value of a Dynamic AFP–LDH Index for Predicting Recurrence After Curative Resection in Hepatocellular Carcinoma

AIM: Although curative resection remains a cornerstone treatment for hepatocellular carcinoma (HCC), recurrence continues to limit durable disease control in a considerable proportion of patients. Improved postoperative risk assessment may facilitate more individualized surveillance and management strategies. Accordingly, we examined the prognostic performance of a dynamic alpha-fetoprotein–lactate dehydrogenase (AFP–LDH) Index in predicting recurrence after curative resection.METHODS: Patients who underwent curative resection for HCC between January 2020 and January 2025 were retrospectively analyzed. The AFP–LDH Index was calculated as log10 (postoperative AFP × LDH / preoperative AFP). Survival probabilities were estimated using the Kaplan–Meier method, and the relationship between clinical variables and outcomes was examined with Cox proportional hazards models. Receiver operating characteristic (ROC) analysis was used to identify the optimal cutoff value. Internal validation of the discriminative performance of the AFP–LDH Index was performed using bootstrap resampling (2000 repetitions), and optimism-corrected area under the curve (AUC) estimates with bootstrap-derived 95% confidence intervals were reported.RESULTS: A total of 50 patients were included, with a median follow-up duration of 27.9 months. Recurrence occurred in 26 patients (52.0%). The median RFS was 23 months (95% confidence interval [CI]: 14.5–31.5). ROC analysis identified an optimal AFP–LDH Index cutoff value of >1.67, demonstrating promising discriminative performance (AUC = 0.960). In multivariable analysis, the AFP–LDH Index remained an independent predictor of recurrence (hazard ratio [HR]: 27.24, 95% CI: 5.41–137.14, p < 0.001). ROC analysis demonstrated good discriminative performance for recurrence prediction (AUC = 0.960; 95% CI: 0.863–0.995; p < 0.001).CONCLUSIONS: The dynamic AFP–LDH Index was independently associated with recurrence risk after curative resection for HCC. This exploratory composite biomarker demonstrated promising prognostic performance; however, further multicenter validation is required before routine clinical application.