影像引导下经皮热消融治疗小的单发肝细胞癌的最佳消融边缘及基于消融边缘的局部复发预测：一项多中心研究

An Optimal Ablative Margin of Small Single Hepatocellular Carcinoma Treated with Image-Guided Percutaneous Thermal Ablation and Local Recurrence Prediction Base on the Ablative Margin: A Multicenter Study.

作者信息

Li Feng-Yao, Li Jian-Guo, Wu Song-Song, Ye Huo-Lin, He Xu-Qi, Zeng Qing-Jing, Zheng Rong-Qin, An Chao, Li Kai

机构信息

Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.

The Department of Infectious Disease,The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.

出版信息

J Hepatocell Carcinoma. 2021 Nov 15;8:1375-1388. doi: 10.2147/JHC.S330746. eCollection 2021.

OBJECTIVE

To explore the best ablative margin (AM) for single hepatocellular carcinoma (HCC) patients with image-guided percutaneous thermal ablation (IPTA) based on MRI-MRI fusion imaging, and to develop and validate a local tumor progression (LTP) predictive model based on the recommended AM.

METHODS

Between March 2014 and August 2019, 444 treatment-naïve patients with single HCC (diameter ≤3 cm) who underwent IPTA as first-line treatment from three hospitals were included, which were randomly divided into training (n= 296) and validation (n = 148) cohorts. We measured the ablative margin (AM) by MRI-MRI fusion imaging based on pre-ablation and post-ablation images. Then, we followed up their LPT and verified the optimal AM. Risk factors related to LTP were explored through Cox regression models, the nomogram was developed to predict the LTP risk base on the risk factors, and subsequently validated. The predictive performance and discrimination were assessed and compared with conventional indices.

RESULTS

The median follow-up was 19.9 months (95% CI 18.0-21.8) for the entire cohort. The results revealed that the tumor size (HR: 2.16; 95% CI 1.25-3.72; P = 0.003) and AM (HR: 0.72; 95% CI, 0.61-0.85; P < 0.001) were independent prognostic factors for LTP. The AM had a pronounced nonlinear impact on LTP, and a cut-off value of 5-mm was optimal. We developed and validated an LTP predictive model based on the linear tumor size and nonlinear AM. The model showed good predictive accuracy and discrimination (training set, concordance index [C-index] of 0.751; validation set, C-index of 0.756) and outperformed other conventional indices.

CONCLUSION

The 5-mm AM is recommended for the best IPTA candidates with single HCC (diameter ≤3 cm). We provided an LTP predictive model that exhibited adequate performance for individualized prediction and risk stratification.

目的

基于磁共振成像-磁共振成像融合成像，探讨影像引导下经皮热消融（IPTA）治疗单发肝细胞癌（HCC）患者的最佳消融边缘（AM），并基于推荐的AM建立和验证局部肿瘤进展（LTP）预测模型。

方法

纳入2014年3月至2019年8月期间来自三家医院的444例未经治疗的单发HCC（直径≤3 cm）患者，这些患者接受IPTA作为一线治疗，并随机分为训练队列（n = 296）和验证队列（n = 148）。我们根据消融前和消融后的图像，通过磁共振成像-磁共振成像融合成像测量消融边缘（AM）。然后，我们对他们的LPT进行随访，并验证最佳AM。通过Cox回归模型探索与LTP相关的危险因素，基于危险因素建立列线图以预测LTP风险，随后进行验证。评估预测性能和辨别力，并与传统指标进行比较。

结果

整个队列的中位随访时间为19.9个月（95% CI 18.0 - 21.8）。结果显示，肿瘤大小（HR：2.16；95% CI 1.25 - 3.72；P = 0.003）和AM（HR：0.72；95% CI，0.61 - 0.85；P < 0.001）是LTP的独立预后因素。AM对LTP有明显的非线性影响，5 mm的截断值是最佳的。我们基于线性肿瘤大小和非线性AM建立并验证了一个LTP预测模型。该模型显示出良好的预测准确性和辨别力（训练集，一致性指数[C-index]为0.751；验证集，C-index为0.756），并且优于其他传统指标。