Lindner C. Letter to the Editor: AADN score predicts overall and progression-free survival in triple therapy for hepatocellular carcinoma. World J Gastroenterol 2026; 32(13): 116481 [DOI: 10.3748/wjg.v32.i13.116481]
Corresponding Author of This Article
Cristian Lindner, MD, Doctor, Department of Radiology, Faculty of Medicine, University of Concepción, San Martín 1436, Concepción 4030000, Chile. clindner146@gmail.com
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Oncology
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Apr 7, 2026 (publication date) through Mar 27, 2026
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World Journal of Gastroenterology
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1007-9327
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Lindner C. Letter to the Editor: AADN score predicts overall and progression-free survival in triple therapy for hepatocellular carcinoma. World J Gastroenterol 2026; 32(13): 116481 [DOI: 10.3748/wjg.v32.i13.116481]
World J Gastroenterol. Apr 7, 2026; 32(13): 116481 Published online Apr 7, 2026. doi: 10.3748/wjg.v32.i13.116481
Letter to the Editor: AADN score predicts overall and progression-free survival in triple therapy for hepatocellular carcinoma
Cristian Lindner
Cristian Lindner, Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
Cristian Lindner, Department of Radiology, Hospital Clínico Regional Dr. Guillermo Grant Benavente, Concepción 4030000, Chile
Author contributions: Lindner C wrote this manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Cristian Lindner, MD, Doctor, Department of Radiology, Faculty of Medicine, University of Concepción, San Martín 1436, Concepción 4030000, Chile. clindner146@gmail.com
Received: November 13, 2025 Revised: December 18, 2025 Accepted: January 19, 2026 Published online: April 7, 2026 Processing time: 135 Days and 4 Hours
Abstract
The integration of transarterial chemoembolization with immune checkpoint inhibitors and tyrosine kinase inhibitors has reshaped the therapeutic landscape of unresectable hepatocellular carcinoma. Nonetheless, outcome heterogeneity remains substantial, underscoring the need for simple and biologically grounded prognostic tools. In this recent issue of the World Journal of Gastroenterology, Zhang et al propose the AADN score, a laboratory-based model incorporating alpha-fetoprotein, alkaline phosphatase, direct bilirubin, and neutrophil-to-lymphocyte ratio. Developed using multivariable regression and validated in an independent cohort, the AADN score demonstrated good discrimination for overall and progression-free survival. This article contextualizes the score within existing prognostic systems, discusses its biological plausibility and methodological considerations, and critically appraises its current level of evidence. While the AADN score shows promise for risk stratification and hypothesis generation, further prospective and multicenter validation is required before it can inform routine clinical decision-making.
Core Tip: The AADN score, derived from alpha-fetoprotein, alkaline phosphatase, direct bilirubin, and neutrophil-to-lymphocyte ratio, provides a simple yet powerful tool to predict overall and progression-free survival in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization, sintilimab, and lenvatinib. By integrating markers of tumor biology, hepatic function, and systemic inflammation, this model enables individualized risk stratification and supports precision-based decision-making in triple therapy for hepatocellular carcinoma.
