Abstract
PurposeHepatocellular carcinoma (HCC) patients usually achieve a complete response after treatment. This study was aimed to assess the clinical outcome of HCC patients who had achieved a complete response but later presented with elevated tumor marker levels without an identifiable recurrent tumor on gadoxetic acid-enhanced magnetic resonance imaging (MRI).MethodsWe retrospectively reviewed the clinical outcome of 58 HCC treated patients who had achieved a complete response but later was referred to our institution’s multidisciplinary tumor board for a clinically suspected hidden HCC recurrence based on elevated tumor marker levels but negative gadoxetic acid-enhanced MRI. The imaging studies, tumor markers, and clinical information were reviewed. The total follow-up period was at least 15 months after the initial negative gadoxetic acid-enhanced MRI.ResultsFollow-up imaging studies detected an HCC lesion in 89.7% (n = 52/58) of the patients within the study period, and approximately half of the tumors (46.2%, n = 24/52) developed within 3 months. The most frequent site of recurrence was the liver (86.5%; n = 45/52), but extra-hepatic metastasis was also common (19.2%; n = 10/52). In 5.8% (n = 3/52), HCC reoccurred in the combined form of intra-hepatic and extra-hepatic recurrence. Extra-hepatic metastasis alone occurred in 13.5% (n = 7/52) of patients.ConclusionsHCC frequently recurred within a short interval in patients who achieved a complete response to treatment in the presence of increased tumor marker levels, even if gadoxetic acid-enhanced MRI was negative. Under such circumstances, we suggest a short-term follow-up including, but not limited to, gadoxetic acid-enhanced MRI along with systemic evaluation.
Highlights
Magnetic resonance imaging (MRI) plays an essential role in the detection and diagnosis of hepatocellular carcinoma (HCC) [1, 2]
We retrospectively reviewed the clinical outcome of 58 HCC treated patients who had achieved a complete response but later was referred to our institution’s multidisciplinary tumor board for a clinically suspected hidden HCC recurrence based on elevated tumor marker levels but negative gadoxetic acid-enhanced MRI
HCC frequently recurred within a short interval in patients who achieved a complete response to treatment in the presence of increased tumor marker levels, even if gadoxetic acid-enhanced MRI was negative
Summary
Magnetic resonance imaging (MRI) plays an essential role in the detection and diagnosis of hepatocellular carcinoma (HCC) [1, 2]. MRI has excellent diagnostic performance for predicting complete pathological necrosis in HCC patients treated with loco-regional therapy [3]. Progress in HCC management has resulted in various treatment options, including surgical resection, liver transplantation, and local directive therapies, such as radiofrequency ablation, cryoablation, radioembolization, transarterial chemoembolization, and stereotactic body radiation therapy [4, 5]. Complete responses to treatment are more frequent in patients with HCC. The early detection of a recurrent tumor allows for possible reapplication of curative treatment modalities [6, 7]. The demand for effective post-treatment surveillance enabling early detection of potential tumor recurrence is increasing
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