Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Br J Radiol. 2024 Mar 28;97(1156):844-849. doi: 10.1093/bjr/tqae038.
Although radiofrequency ablation (RFA) has been considered as the favourable treatment option for hepatocellular carcinoma (HCC), there still exist some challenges for new recurrence after RFA. The present study aims to determine the factors affecting recurrence and develop an effective model to predict intrahepatic recurrence-free survival (RFS).
Patients with HCC followed by RFA between 2000 and 2021 were included in this study. Multivariable Cox regression analysis was used to determine the independent prognostic factors and establish the nomogram predicting intrahepatic RFS after RFA. The predictive performance of the nomogram was assessed according to the C-index, calibration plots, and Kaplan-Meier curves stratified by the tertiles.
A total of 801 sessions in 660 patients (including 1155 lesions) were enrolled into this study. Intrahepatic new recurrence was observed in all patients during the follow-up, and the mean intrahepatic RFS was 21.9 months in the present cohort. According to multivariate COX regression analysis, five independent prognostic factors affecting intrahepatic RFS were determined, including age, Child-Pugh class, tumour distribution, number of tumours, and a-fetoprotein (AFP). Based on all independent prognostic factors, the nomogram model was developed and evaluated, which achieved favourable discrimination and calibration.
This study established five independent prognostic factors and constructed a nomogram model to predict intrahepatic RFS for HCC patients followed by RFA. It could better help clinicians select RFA candidates, as well as offering the important information about whether patients need receive comprehensive treatment to prevent new recurrence after RFA.
(1) In this study, 5 preoperative clinic-pathological variables were determined as the independent prognostic factors affecting RFS after RFA in the current largest sample size. (2) Based on these independent prognostic factors, a prognostic nomogram predicting RFS after RFA was established, which may be used to select patients who benefit from RFA and could help both surgeons and patients provide useful information for choosing the personalized treatment.
射频消融（RFA）已被认为是治疗肝细胞癌（HCC）的有利选择，但 RFA 后仍存在一些新复发的挑战。本研究旨在确定影响复发的因素，并建立一种有效的模型来预测肝内无复发生存（RFS）。
本研究纳入了 2000 年至 2021 年接受 RFA 治疗的 HCC 患者。采用多变量 Cox 回归分析确定独立的预后因素，并建立预测 RFA 后肝内 RFS 的列线图。根据 C 指数、校准图和按三分位数分层的 Kaplan-Meier 曲线评估列线图的预测性能。
本研究共纳入 660 例患者的 801 次 RFA 治疗（共 1155 个病灶）。所有患者在随访期间均出现肝内新发复发，本队列的平均肝内 RFS 为 21.9 个月。根据多变量 COX 回归分析，确定了 5 个影响肝内 RFS 的独立预后因素，包括年龄、Child-Pugh 分级、肿瘤分布、肿瘤数量和甲胎蛋白（AFP）。基于所有独立的预后因素，建立并评估了列线图模型，该模型具有良好的区分度和校准度。
本研究确定了 5 个独立的预后因素，并构建了一个列线图模型，以预测接受 RFA 治疗的 HCC 患者的肝内 RFS。它可以更好地帮助临床医生选择 RFA 候选者，并为患者提供有关是否需要接受综合治疗以防止 RFA 后新复发的重要信息。
（1）在这项研究中，确定了 5 个术前临床病理变量作为影响 RFA 后 RFS 的独立预后因素，这是目前最大样本量的研究。（2）基于这些独立的预后因素，建立了一个预测 RFA 后 RFS 的预后列线图，可用于选择从 RFA 中获益的患者，并帮助外科医生和患者为选择个性化治疗提供有用信息。
