A New Prognostic Model Of Early Tumor Progression After Local Thermal Ablation Of Hepatocellular Carcinoma

Objective It is very common that early recurrence of hepatocellular carcinoma?HCC?after local thermal ablation and the factors of early recurrence are unclear.The purpose of this study was to determine the potential risk factors for early recurrence in HCC patients within 1 year after thermal ablation and to establish a multifactorial model for predicting early tumor progression in HCC patients after local ablation.Methods From January 2014 to December 2015,a total of 607 patients underwent ultrasound-guided thermal ablation for the treatment of liver cancer in the Third Central Hospital of Tianjin.The clinical data of 244 patients who met the inclusion criteria were retrospectively analyzed.Clinical data including sex,age,whether joint hepatic artery catheter chemoembolization?TACE?treatment,the types of hepatitis,child classification of liver function,serum albumin?ALB?,alanine aminotransferase?ALT?,glutamyl transpeptidase?GGT?,alkaline phosphatase?ALP?,total bilirubin?Tbil?,platelet count,prothrombin time,tumor size,tumor number,tumor location?whether near blood vessels and important organs,etc.?,alpha fetoprotein?AFP?,treatment methods,etc.Logistic regression was used to analyze the related factors affecting the early tumor progression after HCC thermal ablation,and Logistic regression multivariate analysis was used to screen out independent risk factors affecting the early tumor progression after HCC thermal ablation,and establish a multivariate model for predicting the early tumor progression.Cox regression analysis was used to analyze the risk factors for tumor-free survival after HCC thermal ablation.Results By the end of follow-up,234 patients were enrolled,including 171 males and63 females,with an average age of 58.4 years,an average tumor size of 2.6cm,and an average number of 1.3 tumors.A total of 134 patients with HCC were confirmed to have recurrence after ablation,with a recurrence rate of 54.9%,including 59 patients with early recurrence and the early recurrence rate was 24.1%.Univariate Logistic regression analysis showed that the combination of TACE treatment,maximum tumor diameter,number of tumors,tumor location,hepatitis B,platelet,albumin and bilirubin were related risk factors for early tumor progression after thermal ablation.Logistic regression analysis showed that multiple factors whether joint hepatic artery catheter chemoembolization?TACE?therapy?p=0.037??X₁?,tumor diameter?p=0.009??X₂?,tumor location?p=0.039??X₃?,and hepatitis B?p=0.015??X₄?,platelet levels?p=0.035??X₅?,the differential has a statistical significance,and it has a multi-factor model to predict the early stages of the tumor:Y=0.37 X₁+0.38 X₂+2.68 X₃+0.47 X₄+0.46 X₅+3.48.The area under the ROC curve?AUC?of the new model was 0.76,and the sensitivity and specificity were 81%and 64%,respectively.Cox regression single-factor analysis showed that tumor number,maximum tumor diameter,preoperative AFP level,GGT level,ALB level and platelet count were related risk factors affecting tumor-free survival after thermal ablation.Cox regression multifactor analysis showed that tumor number?p=0.009?,maximum tumor diameter?p=0.021?,preoperative AFP level?p=0.017?,GGT level?p=0.039?and ALB?p=0.009?were independent factors influencing tumor-free survival after thermal ablation.Conclusion Thermal ablation is a relatively safe and effective method for tumor control,but it has a certain risk of recurrence.Strict patient selection and follow-up are mandatory.Logistic regression multivariate analysis showed that the combination of TACE treatment,maximum tumor diameter,tumor location,hepatitis B,and platelet level were independent risk factors for early recurrence of HCC after ablation.For patients with the largest diameter of the lesion>3 cm,or a patient with tumor adjacent to the site of danger or platelet>100x 109/L,the early recurrence should be closely monitored after the primary tumor has been completely abled.Comprehensive or systematic treatment evaluation studies should be conducted to improve disease-free and overall survival.By establishing a new model,it's a better way to predict the early recurrence of HCC patients after thermal ablation.