Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Pain Physician. 2023 Jul;26(4):E341-E352.
Computed tomography-guided percutaneous selective radiofrequency thermocoagulation (RFT) of the trigeminal nerve is a novel, minimally invasive technique for the treatment of trigeminal neuralgia, but the high recurrence rate after surgery might pose a serious problem.
The purpose of this study was to explore the risk factors affecting the recurrence rate after RFT and to predict the recurrence rate and provide evidence for the early prediction.
A single-center retrospective study.
This study was carried out in the Affiliated Hospital of Jiaxing University in China.
One hundred thirty-nine patients were included in this study. The cumulative survival rates according to temperature and type of pain were estimated by the Kaplan-Meier analysis. The least absolute shrinkage and selection operator Cox regression model was used to build the nomogram. Time-independent receiver operating characteristic curve analysis confirmed the signature's predictive capacity. A calibration curve was generated to judge the accuracy of absolute risk predictions, and Brier scores were used to quantitatively evaluate the calibration. Decision curve analysis was applied to comprehensively evaluate the clinical effectiveness of the model. A multiparameter nomogram was used to analyze the scores and predict the risk of relapse.
Three predictors were screened by multivariate Cox regression analysis. Pain grade (refit hazard ratio [HR]: 1.6807; 95% confidence interval [CI]: 1.1963-2.3613) and type of pain (HR: 6.2802; 95% CI: 3.3705-11.7021) were considered to be risk factors affecting the recurrence rate after RFT, while temperature (HR: 0.5203; 95% CI: 0.2859-0.9468) was identified as a protective factor. The recurrence rate within 2 years in 85°C group was 51.09%, while that in 95°C group was 29.79%. The nomogram exhibited good discrimination and calibration. Compared with the preoperative period, all of the patients' postoperative Numeric Rating Scale scores (NRS-11)decreased significantly (P < 0.05). The main postoperative complication was numbness, with a gradual decrease in the Barrow Neurological Institute score over time. Autonomic symptoms and decrease of masticatory muscle function were the secondary postoperative complications, and no other adverse events were observed. Overall patient satisfaction at 2 years postoperatively was 7.83 ± 1.93.
This study contains a small sample size from a single center and the conclusion of randomized controlled trials will be more convincing.
Increasing temperature can effectively reduce the recurrence rate after RF, and the combination of atypical pain and higher NRS-11s could be a risk factor increasing the recurrence rate. The novel nomogram exhibited favorable survival stratification accuracy and shown a great potential for screening high-risk groups and evaluating the risk of recurrence rate.
计算机断层扫描引导下经皮选择性射频热凝术（RFT）是治疗三叉神经痛的一种新的微创技术，但手术后的高复发率可能是一个严重的问题。
本研究旨在探讨影响 RFT 后复发率的危险因素，并预测复发率，为早期预测提供依据。
单中心回顾性研究。
本研究在中国嘉兴大学附属医院进行。
本研究纳入了 139 例患者。采用 Kaplan-Meier 分析估计按温度和疼痛类型的累积生存率。采用最小绝对收缩和选择算子 Cox 回归模型建立列线图。时间独立的接受者操作特征曲线分析确认了特征的预测能力。生成校准曲线以判断绝对风险预测的准确性，并使用 Brier 评分定量评估校准。决策曲线分析用于综合评估模型的临床效果。使用多参数列线图分析评分并预测复发风险。
多因素 Cox 回归分析筛选出 3 个预测因子。疼痛程度（再拟合风险比[HR]：1.6807；95%置信区间[CI]：1.1963-2.3613）和疼痛类型（HR：6.2802；95%CI：3.3705-11.7021）被认为是影响 RFT 后复发率的危险因素，而温度（HR：0.5203；95%CI：0.2859-0.9468）则被认为是保护因素。85°C 组 2 年内的复发率为 51.09%，而 95°C 组的复发率为 29.79%。列线图具有良好的判别力和校准度。与术前相比，所有患者术后数字评分量表（NRS-11）评分均显著降低（P<0.05）。术后主要并发症为麻木，巴罗神经研究所（Barr ow Neurological Institute，B NI）评分随时间逐渐降低。自主症状和咀嚼肌功能下降是次要的术后并发症，未观察到其他不良事件。术后 2 年总体患者满意度为 7.83±1.93。
本研究样本量较小，来自单一中心，随机对照试验的结论将更有说服力。
升高温度可有效降低 RFT 后的复发率，而不典型疼痛和更高的 NRS-11 可能是增加复发率的危险因素。新的列线图表现出良好的生存分层准确性，并显示出筛查高危人群和评估复发率风险的巨大潜力。
