Abstract
Objectives: Liver resection is potentially curative for early-stage hepatocellular carcinoma (eHCC) in patients with well-preserved liver function. The prognosis of these patients after resection is still unsatisfactory because of frequent early recurrence (ER). Therefore, we investigated the role of preoperative dynamic contrast-enhanced 3.0-T MR imaging in predicting ER of eHCC after curative resection.Methods From May 2014 to October 2017, we retrospectively analyzed 82 patients with eHCC who underwent dynamic MR imaging and subsequently underwent curative resection. Liver Imaging Reporting and Data System (LI-RADS) v2018 major and ancillary imaging features, as well as two non-LI-RADS MR imaging features (irregular tumor margin and tumor number), were evaluated. A multivariate Cox regression analysis was used to identify independent predictors, and two models (preoperative and postoperative prediction models) were developed.Results ER was observed in 25 patients (25/82, 30.5%). In the univariate analyses, preoperative alpha-fetoprotein (AFP) level >200 ng/ml, three MR imaging features (multifocal tumors, corona enhancement, and irregular tumor margin), and microvascular invasion (MVI) were associated with ER. In the multivariate analysis, corona enhancement (hazard ratio [HR]: 2.970; p = 0.013) and irregular tumor margin (HR: 2.377; p = 0.048) were independent predictors in the preoperative prediction model, and preoperative AFP level >200 ng/ml (HR: 2.493; p = 0.044) plus corona enhancement (HR: 3.046; p = 0.014) were independent predictors in the postoperative prediction model (microvascular invasion [MVI] was not; p = 0.061). When combined with both predictors, the specificity for ER in the preoperative prediction model was 98.2% (56/57), which was comparable to that of the postoperative prediction model [96.7% (55/57)].Conclusions Our results demonstrated that preoperative MR imaging features (corona enhancement and irregular tumor margin) have the potential to preoperatively identify high-risk ER patients with eHCC, with a specificity >90%.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer and is the third leading cause of cancer-related deaths worldwide [1]
We excluded 40 patients for the following reasons: prior localregional therapy (n = 15); the interval between MR examination and surgery was longer than 1 month (n = 12); MR imaging was performed at an outside hospital (n = 6); HCC with macrovascular invasion was observed on MR imaging (n = 4); and surgical complications resulted in an early death (n = 3)
Recurrence was observed in 31 patients: early recurrence (ER) in 25 patients (25/82, 30.5%) and later recurrence (>1 year) in 6 patients (14, 16, 21, 30, 33, and 42 months)
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer and is the third leading cause of cancer-related deaths worldwide [1]. The frequency of detection of earlystage hepatocellular carcinoma (eHCC, defined as up to three nodules with diameter ≤3 cm) has increased due to the screening of high-risk populations and advances in imaging techniques [2]. Early recurrence (ER), defined as intrahepatic, regional, or systemic recurrence within 12 months after resection, occurs in ∼20–40% of eHCC patients and is the leading cause of postoperative death [3, 4]. Previous studies have suggested that clinicopathological variables, including the presence of microvascular invasion (MVI), worse histological differentiation, microsatellite nodules, alpha-fetoprotein (AFP) level, and tumor size, were significant predictors for ER patients with eHCC after curative resection, but controversy exists as to which of these are more important, and some of these predictors can only be evaluated with postoperative pathological examination [5,6,7]
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