Risk Group Stratification for True Early Recurrence After Ablation for Hepatomas

BACKGROUND: Hepatocellular carcinoma (HCC) is a lethal cancer. Early recurrence, i.e., recurrence within two years of curative treatment, is a major determinant of ultimate survival. MATERIALS AND METHODS: We included 625 patients with newly diagnosed early-stage HCC, i.e., Barcelona Clinic Liver Cancer (BCLC) Stage 0 or A, and Child-Pugh Class A liver disease who underwent percutaneous radiofrequency ablation (RFA) between 2011 and 2021 at our institution with a follow-up period of > 2 years. The patients were divided into Group 1 (patients who developed nonlocal recurrence or died within two years after RFA; n = 300 [48.0%]) and Group 2 (patients who developed local recurrence within two years or were recurrence-free and were alive for two years after RFA; n = 325 [52.0%]). RESULTS: Multivariate analysis showed that a Model for End-Stage Liver Disease (MELD) score of > 9, anti-hepatitis C virus (HCV) positivity, the presence of image-defined cirrhosis, treatment with antiviral therapies for hepatitis B virus or HCV, alpha-fetoprotein ≥ 20 ng/mL, multiple tumors, and larger tumor size were independent factors associated with Group 1. A nomogram was developed based on these variables to predict Group 1, with a concordance index of 68.3% (95% CI = 64.1%-72.5%). The 10-year overall survival of Group 1 was 28%, and that of Group 2 was 64%. CONCLUSION: We developed a nomogram to predict true early recurrence (i.e., nonlocal recurrence) of HCC after RFA.