Patterns and Prognostic Stratification of Recurrence after Thermal Ablation in Patients with Hepatocellular Carcinoma.
[BACKGROUND] Recurrence rates following thermal ablation for hepatocellular carcinoma (HCC) remain high, but the patterns of recurrence and post-recurrence outcomes are not well characterized.
- 추적기간 54.5 months
APA
Tan CP, Lee TY, et al. (2025). Patterns and Prognostic Stratification of Recurrence after Thermal Ablation in Patients with Hepatocellular Carcinoma.. Liver cancer. https://doi.org/10.1159/000550105
MLA
Tan CP, et al.. "Patterns and Prognostic Stratification of Recurrence after Thermal Ablation in Patients with Hepatocellular Carcinoma.." Liver cancer, 2025.
PMID
41607860
Abstract
[BACKGROUND] Recurrence rates following thermal ablation for hepatocellular carcinoma (HCC) remain high, but the patterns of recurrence and post-recurrence outcomes are not well characterized. This study aimed to investigate the recurrence patterns and long-term post-recurrence survival (PRS) in patients with HCC after thermal ablation to inform post-recurrence treatment strategy.
[METHODS] A retrospective analysis was conducted on 824 patients who underwent thermal ablation for HCC between 2007 and 2023. Recurrence patterns and factors influencing PRS in patients with recurrence within and beyond the Milan criteria were evaluated. An independent cohort of 198 patients served as an external validation cohort for the prognostic models.
[RESULTS] During a median follow-up of 54.5 months, 536 patients experienced HCC recurrence, with 83.8% within and 16.2% beyond Milan criteria. For patients with recurrence within Milan criteria, early recurrence, recurrent tumor size, AFP, ALBI grade, and FIB-4 score were independent predictors of PRS. In patients with recurrence beyond Milan criteria, diabetes mellitus, macrovascular invasion, AFP, ALBI grade, and FIB-4 score independently predicted PRS. Based on PRS predictors, a risk model stratified patients with recurrence within Milan criteria into four risk groups, with median PRS of 103.7, 65, 48.7, and 28.6 months, respectively ( < 0.001). For recurrence beyond Milan criteria, a separate risk model classified patients into three risk groups, showing median PRS of 70.1, 24.7, and 8.1 months, along with probabilities of successful downstaging of 66.7%, 39.3%, and 0%, respectively ( < 0.001). The external validation results showed that both the Milan-in and Milan-out models demonstrated significant discriminative performance in the validation cohort.
[CONCLUSIONS] PRS in patients with recurrent HCC after thermal ablation is significantly influenced by recurrence patterns, tumor characteristics, and host factors. These findings may guide post-recurrence treatment strategies and optimize the timing of salvage liver transplantation.
[METHODS] A retrospective analysis was conducted on 824 patients who underwent thermal ablation for HCC between 2007 and 2023. Recurrence patterns and factors influencing PRS in patients with recurrence within and beyond the Milan criteria were evaluated. An independent cohort of 198 patients served as an external validation cohort for the prognostic models.
[RESULTS] During a median follow-up of 54.5 months, 536 patients experienced HCC recurrence, with 83.8% within and 16.2% beyond Milan criteria. For patients with recurrence within Milan criteria, early recurrence, recurrent tumor size, AFP, ALBI grade, and FIB-4 score were independent predictors of PRS. In patients with recurrence beyond Milan criteria, diabetes mellitus, macrovascular invasion, AFP, ALBI grade, and FIB-4 score independently predicted PRS. Based on PRS predictors, a risk model stratified patients with recurrence within Milan criteria into four risk groups, with median PRS of 103.7, 65, 48.7, and 28.6 months, respectively ( < 0.001). For recurrence beyond Milan criteria, a separate risk model classified patients into three risk groups, showing median PRS of 70.1, 24.7, and 8.1 months, along with probabilities of successful downstaging of 66.7%, 39.3%, and 0%, respectively ( < 0.001). The external validation results showed that both the Milan-in and Milan-out models demonstrated significant discriminative performance in the validation cohort.
[CONCLUSIONS] PRS in patients with recurrent HCC after thermal ablation is significantly influenced by recurrence patterns, tumor characteristics, and host factors. These findings may guide post-recurrence treatment strategies and optimize the timing of salvage liver transplantation.