A predictive model for optimal CT-guided thermal ablation margins in liver malignancies ≤3 cm: a retrospective cohort study

作者：Zhenkang Qiu, Guobao Wang, Zixiong Chen, Yuzhe Cao, Guisong Wang, Zhihui Zhong, Lijie Qiu, Tian Gao, Jingshuo Li, Han Qi, Fei Gao · 发表于：International Journal of Surgery · 年份：2026 · DOI：10.1097/js9.0000000000004764 · 被引用次数：1 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Advanced Radiotherapy Techniques、Management of metastatic bone disease

BACKGROUND AND AIMS: Standardized quantitative criteria are lacking for the recommended circumferential thermal ablative margin in liver malignancies ≤3 cm. This study aimed to identify predictors of technical success in thermal ablation and develop a predictive model defining optimal ablation margins. METHODS: This retrospective study analyzed 979 patients undergoing computed tomography-guided radiofrequency or microwave ablation for liver malignancies ≤3 cm. Using a radiotherapy treatment planning system, preoperative tumor dimensions [maximum tumor area, preoperative maximum tumor area (PreMTA); tumor volume, preoperative tumor volume (PreTV)] and postoperative ablation characteristics [maximum ablation area, postoperative maximum ablation area (Post-MAA); ablation volume, postoperative ablation volume (PostAV)] were volumetrically quantified. Volume ratio (PostAV/PreTV) and area ratio (PostMAA/PreMTA) were calculated. Univariate and multivariate logistic regression identified predictors of residual tumor. A nomogram was developed and validated using Harrell's C-index, calibration curves, and receiver operating characteristic analysis. Size- and location-specific margin recommendations were derived mathematically. RESULTS: Residual tumor occurred in 91 patients (9.3%). Multivariate analysis identified adjacent large vessel [odd ratio (OR) = 1.97; P = 0.015], larger PreMTA (OR = 1.44; P = 0.014), and lower volume ratio (OR = 0.77; P = 0.009) as independent predictors. For n...