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Gadoxetic acid-enhanced Liver MR can predict tumor recurrence after curative treatment for small single hepatocellular carcinoma
Dong Ho Lee1 and Jeong Min Lee2

1Radiology, Seoul National University Hospital, Seoul, Korea, Republic of, 2Seoul National University Hospital, Seoul, Korea, Republic of

Synopsis

Non-smooth tumor margins and the presence of non-hypervascular HBP hypointense nodules were demonstrated to be independent significant predictive factors of tumor recurrence after either hepatic resection or RFA.

Background & Aims: Gadoxetic acid-enhanced MR may provide prognostic information for hepatocellular carcinoma (HCC) patients. The aim of this study was to determine the significant predictive factors of tumor recurrence after curative treatment for single nodular HCCs ≤ 3 cm.

Methods: A total of 373 patients with single nodular HCCs ≤ 3 cm who underwent pre-treatment gadoxetic acid-enhanced MR followed by hepatic resection (n=143) or radiofrequency ablation (RFA) (n=230) were included. We retrospectively analyzed their clinicopathological and MR imaging features to determine which features may help predict presence of microvascular invasion (MVI) or recurrence-free survival (RFS). RFS was estimated using Kaplan-Meier analysis and significant predictive MR findings for RFS were evaluated using the Cox-proportional hazard regression model.

Results: Non-smooth tumor margins on hepatobiliary phase (HBP) imaging were significantly associated with MVI in 143 patients treated by hepatic resection (P=0.048, odds ratio=2.60 [1.01-6.69]). In addition, non-smooth tumor margins (Hepatic resection: P=0.012, hazard ratio [HR]=2.17 [1.19-3.97]; RFA: P=0.019, HR=1.79 [1.10-2.91]) and the presence of non-hypervascular HBP hypointense nodules (Hepatic resection: P=0.001, HR=3.55 [1.74-7.23]; RFA: P<0.001, HR=2.12 [1.40-3.20]) were demonstrated to be significant negative predictive factors of RFS after both hepatic resection and RFA. When high risk MR findings for recurrence were defined as the presence of non-smooth tumor margins and/or non-hypervascular HBP hypointense nodules, 5-year RFS in patients with high risk MR findings was significantly lower than in those without after both hepatic resection (31.1% vs. 74.2%, P<0.001, HR=3.56 [1.94-6.55]) and RFA (24.3% vs. 54.6%, P<0.001, HR=2.38 [1.62-3.51]).

Conclusions: Non-smooth tumor margins and the presence of non-hypervascular HBP hypointense nodules were demonstrated to be independent significant predictive factors of tumor recurrence after either hepatic resection or RFA.

Acknowledgements

No acknowledgement found.

References

No reference found.

Figures

(A) Kaplan-Meier estimation of recurrence-free survival in 105 patients without non-smooth tumor margins after hepatic resection compared with 38 patients with non-smooth tumor margins on the HBP. (B) Kaplan-Meier estimation of recurrence-free survival in 129 patients without non-hypervascular HBP hypointense nodules after hepatic resection compared with 14 patients with non-hypervascular HBP hypointense nodules. (C) Kaplan-Meier estimation of recurrence-free survival in 202 patients without non-smooth tumor margins after RFA compared with 28 patients with non-smooth tumor margins on the HBP. (D) Kaplan-Meier estimation of recurrence-free survival in 177 patients without non-hypervascular HBP hypointense nodules after RFA compared with 53 patients with non-hypervascular HBP hypointense nodules.

Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)
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