Abstract
Background/Purpose. The purpose of this study was to clarify whether preoperative gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) and simultaneous treatment of suspected early hepatocellular carcinoma (eHCC) at the time of resection for progressed HCC affected patient prognosis following hepatic resection. Methods. A total of 147 consecutive patients who underwent their first curative hepatic resection for progressed HCC were enrolled. Of these, 77 patients underwent EOB-MRI (EOB-MRI (+)) before hepatic resection and the remaining 70 patients did not (EOB-MRI (−)). Suspected eHCCs detected by preoperative imaging were resected or ablated at the time of resection for progressed HCC. Results. The number of patients who underwent treatment for eHCCs was significantly higher in the EOB-MRI (+) than in the EOB-MRI (−) (17 versus 6; P = 0.04). Recurrence-free survival (1-, 3-, and 5-year; 81.4, 62.6, 48.7% versus 82.1, 41.5, 25.5%, resp., P < 0.01), but not overall survival (1-, 3-, and 5-year; 98.7, 90.7, 80.8% versus 97.0, 86.3, 72.4%, resp., P = 0.38), was significantly better in the EOB-MRI (+). Univariate and multivariate analyses showed that preoperative EOB-MRI was one of the independent factors significantly correlated with better recurrence-free survival. Conclusions. Preoperative EOB-MRI and simultaneous treatment of eHCC prolonged recurrence-free survival after hepatic resection.
Highlights
Hepatocellular carcinoma (HCC) is one of the most malignant tumors worldwide
The number of patients who underwent treatment for early HCC (eHCC) at the time of hepatic resection was significantly higher in the EOB-magnetic resonance imaging (MRI) (+) group than in the EOB-MRI (−) group (17 versus 6; P = 0.04)
To the best of our knowledge, this is the first study to show that simultaneous treatment of eHCC based on the preoperative imaging study including EOB-MRI prolonged recurrence-free survival after hepatic resection for HCC
Summary
Hepatic resection is still the most effective treatment for HCC; the recurrence rate is very high even after curative resection. Anatomic hepatic resection has been shown to be effective for micro IM within resected sections or segments with progressed HCC [7,8,9] but is ineffective for MC in the remnant liver. Recent studies have shown that hypovascular early HCC (eHCC), which is not an indication for resection, progresses to conventional hypervascular HCC. Hypovascular eHCC is thought to be one of the causes of multicentric recurrence of hypervascular HCC after hepatic resection. The effects of simultaneous treatment of suspected eHCC at the time of hepatic resection for progressed HCC on postoperative recurrence have never been evaluated
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