Verhagen Coosje A M, Gholamiankhah Faeze, Buijsman Emma C M, Broersen Alexander, van Erp Gonnie C M, van der Velden Ariadne L, Rahmani Hossein, van der Leij Christiaan, Brecheisen Ralph, Lanocita Rodolfo, Dijkstra Jouke, Burgmans Mark C
Department of Radiology, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands.
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands.
Cancers (Basel). 2025 Aug 14;17(16):2656. doi: 10.3390/cancers17162656.
Early detection of patients at high risk for recurrence or local tumor progression (LTP) following thermal ablation of hepatocellular carcinoma (HCC) is essential for treatment selection and individualized follow-up. This systematic review aims to assess and compare the performance of prognostic models predicting recurrence or LTP in patients with HCC treated with thermal ablation. PubMed, Web of Science, Cochrane, and Embase were searched for studies developing models to predict recurrence after thermal ablation in treatment-naïve HCC patients, using imaging and clinical data with reported test set performance. Risk of bias and applicability were assessed by the Prediction model Risk of Bias Assessment Tool. Data on model performance, feature extraction and modeling technique was collected. In total, 16 studies comprising 39 prognostic models were included, all developed using retrospective data from China or Korea. Outcomes included recurrence-free survival, (intrahepatic) early recurrence, LTP, late recurrence and aggressive intrasegmental recurrence. Predictive parameters varied across models addressing identical outcomes. Outcome definitions also differed. Nine models were externally validated. Most studies had a high risk of bias due to methodological limitations. Variability in model development methodology and type of predictors was found. Models that integrated multiple types of predictors consistently outperformed those relying on one type. To advance predictive tools toward clinical implementation, future research should prioritize standardized outcome definitions, external testing, and transparent reporting. Until these challenges are addressed, current evaluated models should be regarded as promising but preliminary tools.
早期发现肝细胞癌（HCC）热消融术后复发或局部肿瘤进展（LTP）高危患者对于治疗选择和个体化随访至关重要。本系统评价旨在评估和比较预测接受热消融治疗的HCC患者复发或LTP的预后模型的性能。检索了PubMed、科学网、Cochrane和Embase，以查找使用具有报告测试集性能的影像和临床数据来开发预测初治HCC患者热消融后复发模型的研究。通过预测模型偏倚风险评估工具评估偏倚风险和适用性。收集了模型性能、特征提取和建模技术的数据。总共纳入了16项研究，包含39个预后模型，所有模型均使用来自中国或韩国的回顾性数据开发。结局包括无复发生存、（肝内）早期复发、LTP、晚期复发和侵袭性节段内复发。针对相同结局的模型，预测参数各不相同。结局定义也存在差异。9个模型进行了外部验证。由于方法学局限性，大多数研究存在较高的偏倚风险。发现模型开发方法和预测因素类型存在差异。整合多种类型预测因素的模型始终优于依赖单一类型预测因素的模型。为了推动预测工具向临床应用发展，未来研究应优先考虑标准化结局定义、外部测试和透明报告。在这些挑战得到解决之前，目前评估的模型应被视为有前景但尚属初步的工具。
