超越消融难度评分（ADS）：一种预测肝细胞癌微波消融结局的新型消融风险评分（ARS）
该回顾性研究纳入186例肝细胞癌患者共312个病灶，评估超声融合成像辅助微波消融的结局，验证ADS并开发ARS。ARS基于肿瘤数目、直径、邻近胆管胆囊及ALT四个独立风险因素，AUC为0.78，显著优于ADS（AUC 0.53，P<0.001）。ARS有助于介入超声医师优化术前策略和随访计划。
要点
- ARS基于肿瘤数目、直径、邻近胆管胆囊及ALT四个术前因素，可量化预测微波消融不良结局风险。
- ARS的AUC为0.78，显著优于ADS的0.53，提示其更适合当前临床实践。
- 术前应用ARS评估风险，有助于制定个体化消融策略和随访方案。
英文原文（摘要）· 点击展开
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.
引用
- Kang H, Zhu W, Liang S, et al. Beyond the ablation difficulty score (ADS): A novel ablation risk score (ARS) for predicting microwave ablation outcomes in hepatocellular carcinoma. Eur J Radiol. 2026. PMID: 42008887. doi:10.1016/j.ejrad.2026.112870
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。