Aim: The incidence of intrahepatic distant recurrence (IDR) of hepatocellular carcinoma (HCC) still remains high after radiofrequency ablation (RFA). However, serum alpha-fetoprotein (AFP) has insufficient screening power. This study aimed to identify risk factors for IDR in patients with post-RFA HCC.
Method: A total of 112 patients with early-stage HCC who underwent RFA were divided into the IDR (n = 51) and non-IDR groups (n = 61). Serum samples were analyzed within 2 months after RFA.
Results: The mean follow-up duration was 30.1 months. The recurrence-free survival rates at 1, 3, and 5 years were 20.8%, 42.4%, and 54.2%, respectively. The 1- and 5-year overall survival rates were 97.3% and 87.3%, respectively. Univariate and multivariate analyses revealed that the neutrophil-to-lymphocyte ratio [NLR, hazard ratio (HR) 2.40; 95% confidence interval (CI) 1.44-3.99] and lens culinaris agglutinin a-reactive fraction of alpha-fetoprotein (AFP-L3, (HR 1.02; 95% CI 1.01-1.04) were independently associated with post-RFA IDR. The cumulative recurrence rates at 5 years in the high NLR (≥ 2.24) and high AFP-L3 (≥ 0.2 ng/mL) groups were significantly higher than those in the low NLR (< 2.24) and low AFP-L3 (< 0.2 ng/mL) groups, respectively. The predictive accuracies of NLR, AFP-L3, and a composite index based on AFP-L3, and NLR for IDR were 66.2% (37.3% sensitivity, 95.1% specificity), 64.3% (47.1% sensitivity, 80.3% specificity), and 75.6% (68.6% sensitivity, 75.4% specificity), respectively.
Conclusion: The combined model had significantly better prediction performance than either NLR or AFP-L3 alone. The NLR combined with an absolute AFP-L3 level is an effective marker for IDR in patients with post-RFA HCC.
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