Preoperative CT for Characterization of Aggressive Macrotrabecular-Massive Subtype and Vessels That Encapsulate Tumor Clusters Pattern in Hepatocellular Carcinoma.

Zhichao Feng,Huafei Zhao,Qian Chen,Pengfei Rong,Wei Wang,Huiling Li,Yi Jiang,Qin Liu

doi:10.1148/radiol.2021203614

Abstract

Background Macrotrabecular-massive (MTM) subtype and vessels encapsulating tumor clusters (VETC) pattern of hepatocellular carcinoma (HCC) are associated with unfavorable prognosis. Purpose To estimate the potential of preoperative CT in the prediction of MTM subtype and VETC pattern. Materials and Methods Patients who underwent surgical resection or liver transplant and preoperative CT for HCC between January 2015 and June 2018 were retrospectively included in the primary cohort. CT imaging features were evaluated by two radiologists. Predictors associated with the MTM subtype or VETC pattern were determined by using logistic regression analyses and the performance was tested in a validation cohort. Prognostic factors associated with early recurrence after surgical resection were identified by using Cox regression analyses. Results The primary cohort included 170 patients (median age, 55 years; interquartile range, 48-63 years; 152 men). Serum α-fetoprotein level higher than 100 ng/mL (odds ratio [OR], 4.3; 95% CI: 2.1, 9.2; P < .001), intratumor necrosis (OR, 5.2; 95% CI: 2.5, 11.0; P < .001), and intratumor hemorrhage (OR, 5.4; 95% CI: 1.3, 23.3; P = .02) were independent predictors for MTM subtype, whereas tumor size greater than 5 cm (OR, 3.8; 95% CI: 1.7, 8.1; P = .001) and intratumor necrosis (OR, 2.1; 95% CI: 1.0, 4.4; P = .045) were independent predictors for VETC pattern. These features were used for the construction of ANH and SN scores (where A is α-fetoprotein level, N is necrosis, H is hemorrhage, and S is size), respectively, which showed comparable prediction performance in the primary and validation cohorts. Preoperative high ANH and high SN phenotype (hazard ratio, 1.9; 95% CI: 1.2, 3.0; P = .01) was independently associated with early recurrence after surgical resection. Conclusion Preoperative CT features could be used for the characterization of macrotrabecular-massive subtype and vessels that encapsulate tumor clusters pattern and were of prognostic significance for early recurrence in patients with hepatocellular carcinoma. Online supplemental material is available for this article. See also the editorial by Yoon and Kim in this issue. Published under a CC BY 4.0 license.

Highlights

For patients with hepatocellular carcinoma, intratumor necrosis at CT was predictive of both macrotrabecular-massive subtype and vessels encapsulating tumor clusters pattern, and a distinct CT imaging phenotype was associated with increased risk of early recurrence after surgical resection
Multivariable logistic regression analysis showed that serum -fetoprotein level higher than 100 ng/mL, intratumor necrosis (OR, 5.2; 95% CI: 2.5, 11.0; P .001), and intratumor hemorrhage (OR, 5.4; 95% CI: 1.3, 23.3; P = .02) were independently associated with MTM subtype, whereas tumors larger than 5 cm (OR, 3.8; 95% CI: 1.7, 8.1; P = .001) and intratumor necrosis (OR, 2.1; 95% CI: 1.0, 4.4; P = .045) were associated with vessels encapsulating tumor clusters (VETC) pattern in the primary cohort (Table 4)
We demonstrated that high serum -fetoprotein level, intratumor necrosis, and intratumor hemorrhage at CT were independent predictors for MTM subtype, whereas large tumor size and intratumor necrosis at CT were independent predictors for VETC pattern

Summary

Methods

Patients who underwent surgical resection or liver transplant and preoperative CT for HCC between January 2015 and June 2018 were retrospectively included in the primary cohort. Prognostic factors associated with early recurrence after surgical resection were identified by using Cox regression analyses Patients This retrospective study included a single-center primary cohort for determination of independent features, prediction score development, and prognosis analysis; and a two-center validation cohort for prediction score testing in the characterization of subtypes. Consecutive patients who underwent surgical resection or liver transplant for untreated HCC at the Third Xiangya Hospital of Central South University between January 2015 and June 2018 were reviewed. Patients with HCC at the Third Xiangya Hospital of Central South University and the First People’s Hospital of Yueyang (Yueyang, China) between July 2018 and December 2019 following the above criteria constituted the validation cohort

Results

Discussion

Conclusion