Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Department of Interventional Radiology, First Hospital of Shanxi Medical University, Shanxi Province, Taiyuan, 030001, China.
Eur J Radiol. 2021 May;138:109623. doi: 10.1016/j.ejrad.2021.109623. Epub 2021 Mar 4.
To determine the risk factors and patterns of recurrence after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) meeting the up-to-seven criteria and to develop a nomogram to predict the recurrence free survival (RFS).
This retrospective study included 481 HCC patients meeting the up-to-seven criteria and who received RFA as the primary therapy at three Chinese hospitals from January 2013 to December 2016. All clinical variables were assessed by univariate and multivariate Cox regression analyses and a nomogram was constructed to predict the probability of RFS.
The recurrence rate was 50.7 % (244/481). Age > 60 years, male gender, and multiple tumors were independent risk factors of recurrence. The incidence of early and late recurrence was 68.03 % (n = 166) and 31.97 % (n = 78), respectively. Seven patterns of spatial recurrence were identified: local tumor progression (LTP) alone (n = 18, 7.38 %), intrahepatic distant recurrence (IDR) alone (n = 136, 55.74 %), extrahepatic recurrence (ER) alone (n = 21, 8.61 %), IDR + ER (n = 45, 18.44 %), LTP + IDR (n = 16, 6.56 %), LTP + ER (n = 4, 1.64 %) and LTP + IDR + ER (n = 4, 1.64 %). The 1-, 2-, and 3-year RFS rates were 79.63 %, 65.23 %, and 51.03 %, respectively. A well-discriminated and calibrated nomogram was constructed.
The factors affecting recurrence after RFA were age, gender, and the number of tumors. IDR was the most common type of recurrence after complete ablation.
确定符合 up-to-seven 标准的肝细胞癌 (HCC) 射频消融 (RFA) 后复发的危险因素和模式，并建立预测无复发生存率 (RFS) 的列线图。
本回顾性研究纳入了 2013 年 1 月至 2016 年 12 月期间在中国的三家医院接受 RFA 作为一线治疗的符合 up-to-seven 标准的 481 例 HCC 患者。所有临床变量均通过单因素和多因素 Cox 回归分析进行评估，并构建列线图以预测 RFS 概率。
复发率为 50.7%（244/481）。年龄>60 岁、男性和多个肿瘤是复发的独立危险因素。早期和晚期复发的发生率分别为 68.03%（n=166）和 31.97%（n=78）。共发现 7 种空间复发模式：单纯局部肿瘤进展（LTP）（n=18，7.38%）、单纯肝内远处复发（IDR）（n=136，55.74%）、肝外复发（ER）（n=21，8.61%）、IDR+ER（n=45，18.44%）、LTP+IDR（n=16，6.56%）、LTP+ER（n=4，1.64%）和 LTP+IDR+ER（n=4，1.64%）。1、2 和 3 年 RFS 率分别为 79.63%、65.23%和 51.03%。构建了一个具有良好区分度和校准度的列线图。
影响 RFA 后复发的因素是年龄、性别和肿瘤数量。完全消融后 IDR 是最常见的复发类型。
