Preoperative Gadoxetic Acid-Enhanced MRI Based Nomogram Improves Prediction of Early HCC Recurrence After Ablation Therapy.

Chengguang Hu,Meng Li,Jing Zhang,Yikai Xu,Yuanping Zhou,Lin Dai,Weijia Liao,Yong-Yuan Zhang,Cuirong Tang,Yangda Song,Yuchen Zhou

doi:10.3389/fonc.2021.649682

Abstract

PurposeThis study aimed to identify preoperative gadoxetic acid-enhanced MRI features and establish a nomogram for predicting early recurrence (≤ 2 years) of hepatocellular carcinoma (HCC) after ablation therapy.MethodsA total of 160 patients who underwent gadoxetic acid-enhanced MRI and ablation HCC therapy from January 2015 to June 2018, were included retrospectively and divided into a training cohort (n = 112) and a validation cohort (n = 48). Independent clinical risk factors and gadoxetic acid-enhanced MRI features associated with early recurrence were identified by univariate and multivariate logistic regression analysis and used for construction of a nomogram. The performance of the nomogram was evaluated by discrimination, calibration, and clinical utility.ResultsAlpha-fetoprotein (AFP) level, tumor number, arterial peritumoral enhancement, satellite nodule and peritumoral hypointensity at hepatobiliary phases in the training cohort were identified as independent risk factors for early recurrence after ablation. A new nomogram that was constructed with these five features showed an area under the curve (AUC) of 0.843 (95%CI 0.771-0.916) and 0.835 (95%CI 0.713-0.956) in the training and validation cohort, respectively. The calibration curve and decision curve analysis (DCA) suggested that the nomogram had good consistency and clinical utility.ConclusionsA new nomogram that was constructed using four preoperative gadoxetic acid-enhanced MRI features and serum AFP level can predict the risk of early HCC recurrence after ablation therapy with AUC up to 0.843. The strong performance of this nomogram may help hepatologists to categorize patients’ recurrent risk to guide selecting treatment options and improve postoperative management.

Highlights

Hepatocellular carcinoma (HCC) is the fourth most common cause for cancer-related death worldwide [1] and the second leading cause of years of life lost from cancers globally after lung cancer [2]
Two inclusion criteria applied for enrollment: 1) cirrhotic patients who underwent preoperative gadoxetic acid-enhanced liver MRI were diagnosed with HCC; 2) HCC patients were treated with radiofrequency ablation (RFA) or microwave ablation (MWA)
This study found that arterial peritumoral enhancement, satellite nodule, and peritumoral hypointensity at hepatobiliary phases (HBP) detected by gadoxetic acid-enhanced MRI were independent risk factors for early recurrence after HCC ablation therapy

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fourth most common cause for cancer-related death worldwide [1] and the second leading cause of years of life lost from cancers globally after lung cancer [2]. The pathological, cellular molecular, and immunological classifications of HCC may help predict the therapeutic effectiveness and recurrence probability [5, 6]. These analyses are invasive and may not be available before procedure. The current staging or scoring systems including the American Joint Committee on Cancer stage (AJCC) [7], Japan Integrated Staging (JIS) [8], Barcelona Clinic Liver Center stage (BCLC) [9] were initially designed to cover a full spectrum of HCC patients from early to advanced stages. For patients undergoing ablation therapy for very early or early stage of HCC, the abovementioned scoring systems may offer a general assessment but lack fine resolution and clinical utility in predicting prognosis for those patients

Objectives

Methods

Results

Discussion

Conclusion