Jin-Ming Tian,* Jianan Zhang,* Hang Liu,* Fuming Wang, Qing-Song Yang, Rong Luo, Ji-Jin Yang

Department of Interventional Radiology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ji-Jin Yang; Rong Luo, Department of Interventional Radiology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China, Tel +8617717881246 ; +8613003244733, Email jijinyang@sina.com; 1491121589@qq.com

Objective: To develop and validate a nomogram for identification of hepatocellular carcinoma (HCC) patients unsuitable for percutaneous radiofrequency ablation (RFA) due to severe abdominal pain.
Methods: In this retrospective study, 530 patients with HBV-HCC underwent RFA between February, 2019, and April, 2024, and treated in the affiliated hospital of Changhai Hospital, Naval Medical University. Patients were divided into a modeling group (373 cases) and a validation group (157 cases) at a 7:3 ratio. Pain severity during the heating process of the radiofrequency ablation system was assessed using the Visual Analog Scale (VAS). Logistic regression was used to determine risk factors for severe pain, based on which a nomogram was developed.
Results: Key predictors of severe abdominal pain included tumor distance to capsule < 1cm, tumor distance to portal vein < 1cm, and history of transarterial chemoembolization (TACE) (P< 0.05). The nomogram showed excellent predictive performance with an AUC-ROC of 0.756 for the modeling group and 0.714 for the validation group.
Conclusion: Tumor distance to capsule, tumor distance to portal vein, and TACE history are independent factors influencing severe abdominal pain during radiofrequency ablation in HBV-HCC patients. The nomogram effectively identifies HCC patients at risk of severe pain during RFA, facilitating doctors to decide on better alternative locoregional therapies.

Keywords: hepatocellular carcinoma, abdominal pain, radiofrequency ablation, nomograms