A risk-based post ablation follow-up strategy for hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Oncology
• Medical Imaging & Diagnostics

Background:

• Hepatocellular carcinoma (HCC) recurrence after thermal ablation necessitates long-term patient surveillance.
• Optimal follow-up strategies for HCC post-ablation remain underexplored, impacting patient management.

Purpose of the Study:

• To develop and validate a risk-stratified surveillance strategy for HCC patients following complete thermal ablation.
• To optimize follow-up schedules, balancing early recurrence detection with patient burden.

Main Methods:

• Retrospective analysis of 1008 patients with complete ablation for initial HCC within Milan criteria.
• Application of the Ranger model for low- and high-risk stratification based on recurrence probability.
• Development and validation of risk-based follow-up schedules using internal bootstrap and external cohorts.

Main Results:

• The Ranger model, using GGT, AFP, age, tumor number, and size, stratified patients into low-risk (≤0.63) and high-risk (>0.63) groups.
• A risk-based strategy proposed 10 visits for low-risk and 12 for high-risk patients, versus 14 for the fixed guideline schedule.
• This strategy reduced delayed detection time (DDT) and total visits, with detailed arrangements available online.

Conclusions:

• Risk-stratified surveillance significantly reduces patient burden and enhances early recurrence detection for HCC post-ablation.
• The proposed strategy offers a valuable, standardized reference for clinicians and patients, improving postoperative management.
• The Ranger model facilitates individualized prognosis estimation and follow-up planning, proving more efficient than current guidelines.