Evaluation of a serum tumour marker‐based recurrence prediction model after radiofrequency ablation for hepatocellular carcinoma

Background & aims A recent study showed that serum tumour marker‐based MoRAL score (11×√protein induced by vitamin K absence‐II [PIVKA] +2×√alpha‐foetoprotein [AFP]) can reflect both tumour burden and aggressiveness of hepatocellular carcinoma (HCC). This study aimed to evaluate whether baseline MoRAL score could predict tumour recurrence after radiofrequency ablation (RFA) for very‐early/early‐stage HCC. Methods A total of 576 HCC patients who underwent RFA as initial treatment were enrolled from two tertiary referral hospitals (256 in development cohort and 320 in validation cohort). The primary endpoint was recurrence‐free survival (RFS) and the secondary endpoints included cumulative risks of intrahepatic distant recurrence (IDR) and extrahepatic metastasis (EM). Results In the development cohort, MoRAL score was an independent prognostic factor of RFS (P = .02). The optimal cutoff MoRAL score for predicting RFS was 68. Patients with high MoRAL score (>68) showed significantly shorter RFS than did those with low MoRAL score (hazard ratio [HR] = 2.04, P