Risk Factors for Intrahepatic Distant Recurrence After Radiofrequency Ablation for Hepatocellular Carcinoma

The incidence of intrahepatic distant recurrence (IDR) of hepatocellular carcinoma (HCC) still remains high after radiofrequency ablation (RFA). However, serum alpha-fetoprotein (AFP) has insufficient screening power. This study aimed to identify risk factors for IDR in patients with post-RFA HCC.

A total of 112 patients with early-stage HCC who underwent RFA were divided into the IDR (n = 51) and non-IDR groups (n = 61). Serum samples were analyzed within 2 months after RFA.

The mean follow-up duration was 30.1 months. The recurrence-free survival rates at 1, 3, and 5 years were 20.8%, 42.4%, and 54.2%, respectively. The 1- and 5-year overall survival rates were 97.3% and 87.3%, respectively. Univariate and multivariate analyses revealed that the neutrophil-to-lymphocyte ratio [NLR, hazard ratio (HR) 2.40; 95% confidence interval (CI) 1.44-3.99] and lens culinaris agglutinin a-reactive fraction of alpha-fetoprotein (AFP-L3, (HR 1.02; 95% CI 1.01-1.04) were independently associated with post-RFA IDR. The cumulative recurrence rates at 5 years in the high NLR (≥ 2.24) and high AFP-L3 (≥ 0.2 ng/mL) groups were significantly higher than those in the low NLR (< 2.24) and low AFP-L3 (< 0.2 ng/mL) groups, respectively. The predictive accuracies of NLR, AFP-L3, and a composite index based on AFP-L3, and NLR for IDR were 66.2% (37.3% sensitivity, 95.1% specificity), 64.3% (47.1% sensitivity, 80.3% specificity), and 75.6% (68.6% sensitivity, 75.4% specificity), respectively.

The combined model had significantly better prediction performance than either NLR or AFP-L3 alone. The NLR combined with an absolute AFP-L3 level is an effective marker for IDR in patients with post-RFA HCC.