Predictors of True Early Recurrence in Patients Undergoing Radiofrequency Ablation for Hepatocellular Carcinoma

To analyze risk factors of true early recurrence in patients undergoing radiofrequency ablation (RFA) for early-stage hepatocellular carcinoma (HCC).

We enrolled 791 patients with newly diagnosed early-stage HCC (i.e., within Milan criteria) and Child-Pugh class A liver disease undergoing percutaneous RFA. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. Cox proportional hazards analysis was used to identify prognostic factors associated with early recurrence (i.e., recurrence within 2 years after RFA). Early recurrence was identified in 270 (34.1%) patients. After excluding 33 patients with local tumor progression (LTP) within 2 years of initial RFA, 237 patients were classified as showing true early recurrence. Multivariate analyses showed that multiple tumors (hazard ratio [HR] = 1.526; 95% confidence interval [CI] = 1.143-2.039), alpha-fetoprotein (AFP) level of ≥ 10 ng/mL (HR = 1.533; 95% CI = 1.163-2.021), tumor size per 10 mm increase (HR = 1.019; 95% CI = 1.002-1.036), model for end-stage liver disease (MELD) score per one increase (HR = 1.024; 95% CI = 0.999-1.049), anti-hepatitis C virus (anti-HCV) positivity (HR = 1.635; 95% CI = 1.187-2.252), and being treated with antiviral therapy for HCV (HR = 0.614; 95% CI = 0.434-0.869) were associated with inferior 2-year recurrence-free survival (RFS). We constructed a predictive model with these variables. This model provided three risk strata for 2-year RFS, low risk, medium risk, and high risk, with 2-year RFS of 75%, 58%, and 35%, respectively (p < 0.001).

We developed a risk prediction model to predict true early recurrence in patients undergoing RFA for early-stage HCC.