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

After thermal ablation, patients with hepatocellular carcinoma (HCC) should undergo long-term surveillance for disease relapse. However, the optimal follow-up strategy remains unexplored.

We retrospectively analyzed the clinical data of patients who received complete ablation for initial HCC within the Milan criteria from two tertiary hospitals in China. The Ranger model was applied to develop low- or high-risk stratification for recurrence according to the cut-off value of recurrence probability. The follow-up strategies for each stratification were developed based on monthly probability of recurrence and validated by internal bootstraps and external validation.

In total, 1,008 patients were included. Using a cut-off of 0.63 for the Ranger model-derived 2-year recurrence probability (based on γ-glutamyl transferase, α-fetoprotein, age, tumor number, and tumor size), patients were classified as low risk (≤0.63) or high risk (>0.63). Based on the Ranger model, an optimal surveillance schedule was established to maximize the power of detecting recurrence and reduce the number of total visits. Risk-based strategies were validated by internal bootstrap resampling and an external cohort. The proposed strategy entailed 10 visits for low-risk patients (2 per year for years 1-5) and 12 visits for high-risk patients (5, 4, 1, 1, and 1 in years 1, 2, 3, 4, and 5, respectively), whereas the guideline-recommended fixed schedule called for 14 visits. The risk-based surveillance strategies reduced delayed detection time (DDT) compared with clinical guidelines. Detailed follow-up arrangements are available through an interactive website (http://fahultrasound.site:8622/pafah).

Compared with the fixed guideline schedule, our risk-stratified surveillance strategy reduced patient burden through fewer follow-up visits and enhanced early detection of recurrence in both low-risk and high-risk patients. This strategy provides a valuable reference for clinicians and patients to standardize the follow-up strategy following local ablation.

The Ranger model allows estimation of the prognosis of patients with early-stage HCC undergoing radical ablation and builds a risk-based follow-up strategy for individualized postoperative management. The risk-based follow-up strategy was more efficient in early detection of recurrence without increasing medical costs compared with guidelines. Our interactive website provides a valuable reference for both clinicians and patients to standardize the follow-up of patients with HCC after local ablation.