Virtual navigation-guided radiofrequency ablation for recurrent hepatocellular carcinoma invisible on ultrasound after hepatic resection

Background:No reports are available on the technical efficiency and therapeutic response of virtual navigation(VN)-guided radiofrequency ablation(RFA)for patients with recurrent hepatocellular carcinoma(HCC)after hepatic resection.The aim of this study was to investigate the overall technical performance and outcome of VN-guided RFA in recurrent HCC patients.In addition,a nomogram model was developed to predict the factors influencing the overall survival(OS).Methods:This was a prospective study on 76 recurrent HCC patients who underwent VN-guided RFA between June 2015 and February 2018.The technical feasibility,success,and efficiency,OS,local tumor progression,and complications were evaluated.A multivariate Cox regression analysis was conducted to predict the significant factors,and a nomogram including independent predictive factors was subsequently plotted to predict OS.Results:The technical feasibility,success,and efficiency rates of VN-guided RFA were 86.4%,94.7%,and 97.4%,respectively.The cumulative OS rates at 1-,2-,and 3-year were 88.1%,79.7%,and 71.0%,respectively.The cumulative local tumor progression rates at 1-,2-,and 3-year were 5.5%,8.7%,and 14.0%,respectively.In addition,the minor and major complication rates were 5.3%and 3.9%,respectively.No intervention-related deaths occurred during the follow-up period.The C-index of the OS nomogram in this study was 0.737.Conclusions:VN-guided RFA is an effective therapeutic option in recurrent HCC patients and improves the long-term outcomes especially for the lesions that cannot be detected in the two-dimensional ultrasound.Besides,the nomogram may be a useful supporting tool in predicting OS to estimate the individual survival probability,optimize treatment options,and facilitate decision-making.