Abstract
ObjectivesTo explore the role of preoperative gadoxetic acid–enhanced MRI in stratifying the risk of early recurrence in patients with LR-5 hepatocellular carcinoma (HCC) by LI-RADS v2018 after curative resection.MethodsBetween July 2015 and August 2018, this study evaluated consecutive treatment-naïve at-risk LR-5 HCC patients who underwent gadoxetic acid–enhanced MRI examination within 2 weeks before curative resection. The Cox regression analysis was performed to identify potential predictors of early recurrence. Disease-free survival (DFS) rates were analyzed and compared by using the Kaplan-Meier method and log-rank tests.ResultsFifty-three of 103 (51.5%) patients experienced early recurrence. Three MRI findings were significantly associated with early recurrence: corona enhancement (hazard ratio [HR]: 2.116; p = 0.013), peritumoral hypointensity on hepatobiliary phase (HBP) (HR: 2.262; p = 0.007), and satellite nodule (HR: 2.777; p = 0.005). An additional risk factor was AFP level > 400 ng/mL (HR: 1.975; p = 0.016). Based on the number of MRI predictors, LR-5 HCC patients were stratified into three subgroups: LR-5a (60/103; no predictor), LR-5b (26/103; one predictor), and LR-5c (17/103; two or three predictors), with low, medium, and high risk of early recurrence, respectively. The 2-year DFS rate of LR-5a, LR-5b, and LR-5c patients was 65.0%, 38.5%, and 5.9%, respectively, while the corresponding median DFS was undefined, 17.1 months, and 5.1 months, respectively (p < 0.001).ConclusionsIn at-risk LR-5 HCC patients, corona enhancement, peritumoral hypointensity on HBP, and satellite nodule could be used to preoperatively stratify the risk of early recurrence after hepatectomy.Key Points• Corona enhancement, peritumoral hypointensity on HBP, satellite nodule, and serum AFP level > 400 ng/mL were significant predictors of early recurrence in patients with LR-5 HCC after hepatectomy.• Based on the number of predictive MRI findings, LR-5 HCC patients could be preoperatively stratified into three subgroups: LR-5a, LR-5b, and LR-5c, with significantly different risk of early recurrence and disease-free survival.• Preoperative risk stratification is essential for the identification of patients at increased risk of postoperative early recurrence, which may contribute to risk-based personalized management for LR-5 HCC patients.
Highlights
Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy and the third leading cause of cancer-related deaths [1]
Based on the number of predictive magnetic resonance imaging (MRI) findings, LR-5 HCC patients could be preoperatively stratified into three subgroups: LR-5a, LR-5b, and LR-5c, with significantly different risk of early recurrence and disease-free survival
Emerging pieces of evidence indicated that preoperative magnetic resonance imaging (MRI) findings, such as rim enhancement, peritumoral hypointensity on hepatobiliary phase (HBP), and nonsmooth tumor margin, were independent risk factors of postoperative recurrence or microvascular invasion (MVI)—a potent risk factor of early recurrence of HCC [7,8,9,10,11,12]
Summary
Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy and the third leading cause of cancer-related deaths [1]. Recurrence (within 2 years after surgery) is predominantly attributable to the dissemination of the primary HCC and correlated with tumor-related factors (e.g., microvascular invasion, worse differentiation), whereas late recurrence (beyond 2 years after surgery) is more a result of new malignant clones and related to underlying liver conditions (e.g., liver cirrhosis) [2,3,4,5,6]. Emerging pieces of evidence indicated that preoperative magnetic resonance imaging (MRI) findings, such as rim enhancement, peritumoral hypointensity on hepatobiliary phase (HBP), and nonsmooth tumor margin, were independent risk factors of postoperative recurrence or microvascular invasion (MVI)—a potent risk factor of early recurrence of HCC [7,8,9,10,11,12]. Independent validations of these imaging features remain warranted
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