<p>Development and Validation of a Clinicopathological-Based Nomogram to Predict the Survival Outcome of Patients with Recurrent Hepatocellular Carcinoma After Hepatectomy Who Underwent Microwave Ablation</p>

Abstract

Aim: To develop and validate a nomogram for predicting the overall survival (OS) in patients with recurrent hepatocellular carcinoma (HCC) after hepatectomy who underwent microwave ablation (MWA). Methods: The training cohort included 299 patients with recurrent HCCs after hepatectomy who met the Milan criteria and received MWA from April 2007 to December 2017. Baseline characteristics were collected to identify risk factors for the determination of death after MWA. A multivariate Cox proportional hazards model based on significant risk factors was used to develop the nomogram, which was then assessed for its predictive accuracy using Harrell's C-index and the area under the curve (AUC). The nomogram was validated by internal (n = 240) and external cohorts (n = 205) from another hospital. Results: After a median follow-up of 32.3 months, 38.8% (116/299) of patients had died. Multivariate Cox proportional hazards analyses showed that comorbid disease, early recurrence, and albumin-bilirubin (ALBI) grades 2-3 were independent prognostic factors for poor OS. This nomogram accurately stratified patients into subgroups with low or high risk. The 1-, 3-and 5-year OS rates in the low-risk subgroup were 99.4%, 97.2%, and 86.1%, respectively, and they were 92.8%, 70.3%, and 45.8% in the high-risk subgroup (P < 0.001). The nomogram predicted OS in the training cohort with a C-index score of 0.801 (95% CI 0.761-0.841). The nomogram was validated by internal and external cohorts, with C-index scores of 0.792 (95% CI 0.738-0.846) and 0.744 (95% CI 0.703-0.785), respectively. Conclusion: The nomogram provides individualized risk estimates for long-term OS for patients with recurrent HCC after hepatectomy who underwent MWA.

Radiofrequency Ablation Versus Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

“…The proportion of rHCCs with local recurrences near the site of previous ablation/resection was not able to be determined due to a lack of reporting within the studies. Lastly, other ablative modalities such as MWA for treatment of rHCC were unable to compare as there were insufficient comparative studies [40, 41].…”

Role of modern radiotherapy in managing patients with hepatocellular carcinoma

“…Local therapy includes surgical resection, ablative therapies, and radiotherapy (RT). Ablative therapies include radiofrequency ablation (RFA)[ 5 - 7 ], percutaneous ethanol injection therapy[ 8 ], cryoablation[ 9 ], and microwave[ 10 ]; these modalities can be performed through percutaneous, laparoscopic, or open approaches. Local-regional or so-called arterially directed therapies include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE)[ 5 ], drug-eluting beads (DEB)-TACE[ 11 - 13 ], trans-arterial radioembolization (TARE) with yttrium 90[ 14 , 15 ], and hepatic arterial infusion chemotherapy (HAIC)[ 16 - 18 ].…”