European journal of radiology · 2026
Beyond the ablation difficulty score (ADS): A novel ablation risk score (ARS) for predicting microwave ablation outcomes in hepatocellular carcinoma.
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Kang Haiyu, Zhu Wenguang, Liang Shuang, Liu Huahui, Luo Liping, Wu Shanshan, Liu Ying, Liu Qiqi, Xu Erjiao
Аннотация
OBJECTIVES: To validate the Ablation Difficulty Score (ADS) in predicting the effect of microwave ablation (MWA) for hepatocellular carcinoma (HCC) and develop a more suitable scoring system tailored to current clinical practice by incorporating advanced adjuvant ablation techniques.
MATERIALS AND METHODS: In this retrospective study, patients with HCC who underwent ultrasound fusion imaging-assisted MWA between April 2020 and May 2025 in our hospital were enrolled. Patients were divided into a good ablation effect group and a poor ablation effect group. Poor ablation effect was defined as ablation-related outcomes including residual unablated tumor, local tumor progression (LTP) and major complications. Baseline characteristics and ablation risk factors of the two groups were then compared. Logistic regression was used to identify significant ablation risk factors and develop Ablation Risk Score (ARS) system. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of ADS and ARS for ablation effect.
RESULTS: 186 patients with 312 HCC lesions were included into this study. The overall technique efficacy rate was 99.4%, with 4.8% LTP and 7.0% major complication rate. Tumor number, tumor diameter, adjacent to bile ducts and gallbladder and alanine aminotransferase were independent risk factors for poor ablation effect, which were incorporated into ARS. ARS showed moderate discriminatory performance with an AUC of 0.78(95% CI: 0.71-0.85), yet exhibited significantly superior predictive efficacy compared with ADS (AUC: 0.53, 95% CI: 0.45-0.62, P＜0.001). An online calculator based on these four risk factors was developed to generate prediction probability.
CONCLUSIONS: The novel ARS might be effectively quantified ablation risk, and provided a practical tool for interventional ultrasound physicians to optimize preoperative treatment strategy and follow-up schedules.
MATERIALS AND METHODS: In this retrospective study, patients with HCC who underwent ultrasound fusion imaging-assisted MWA between April 2020 and May 2025 in our hospital were enrolled. Patients were divided into a good ablation effect group and a poor ablation effect group. Poor ablation effect was defined as ablation-related outcomes including residual unablated tumor, local tumor progression (LTP) and major complications. Baseline characteristics and ablation risk factors of the two groups were then compared. Logistic regression was used to identify significant ablation risk factors and develop Ablation Risk Score (ARS) system. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of ADS and ARS for ablation effect.
RESULTS: 186 patients with 312 HCC lesions were included into this study. The overall technique efficacy rate was 99.4%, with 4.8% LTP and 7.0% major complication rate. Tumor number, tumor diameter, adjacent to bile ducts and gallbladder and alanine aminotransferase were independent risk factors for poor ablation effect, which were incorporated into ARS. ARS showed moderate discriminatory performance with an AUC of 0.78(95% CI: 0.71-0.85), yet exhibited significantly superior predictive efficacy compared with ADS (AUC: 0.53, 95% CI: 0.45-0.62, P＜0.001). An online calculator based on these four risk factors was developed to generate prediction probability.
CONCLUSIONS: The novel ARS might be effectively quantified ablation risk, and provided a practical tool for interventional ultrasound physicians to optimize preoperative treatment strategy and follow-up schedules.