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Preoperative Prediction of Hepatocellular Carcinoma with Stem Cell Phenotype on Enhanced Magnetic Resonance Imaging and Its Prognostic Value1Radiology, West China Hospital, Sichuan University, Chengdu, China
Synopsis
Keywords: Liver, Tumor
Hepatocellular carcinoma (HCC) with stem cell phenotype is characterized by activating classic cell proliferation pathways and altering intrinsic regulators, it can stimulate HCC tumor proliferation, make the tumor more prone to recurrence, metastasis and therapy resistance. In this study, we developed an easy-to-use and noninvasive risk score integrating preoperative clinical indicators and enhancement magnetic resonance imaging (MRI) to predict stem cell phenotype HCC.Abstract
Introduction: Hepatocellular carcinoma (HCC) with stem cell phenotype is characterized by activating classic cell proliferation pathways and altering intrinsic regulators, it can stimulate HCC tumor proliferation, make the tumor more prone to recurrence, metastasis and therapy resistance. However, its evaluation still relies on invasive histopathologic examination. Therefore, we aimed to develop an easy-to-use and noninvasive risk score integrating preoperative clinical indicators and enhancement magnetic resonance imaging (MRI) to predict stem cell phenotype HCC.Methods: This retrospective study included consecutive patients with hepatectomy and pathological confirmed solitary HCC who underwent preoperative enhancement MRI between January 2010 and May 2021. MRI features were independently evaluated by two abdominal radiologists and the stem cell phenotype HCC was determined by two liver pathologists. For predictive the stem cell phenotype HCC, a scoring system was developed on the training dataset via logistical regression analysis. Model performances were assessed by computing areas under the curve (AUCs) of receiver operating characteristic (ROC). Survival outcomes were evaluated using the Kaplan-Meier method and compared with the log-rank test.
Results: A total of 334 patients (training set, n=232; independent external validation set, n=83) with solitary HCC (138 with stem cell phenotype positive HCC) were included in this study. Four enhancement MRI features were assigned into the stem cell phenotype HCC predictive model (with a scoring system) which including “rim arterial phase hyperenhancement (APHE)” (OR=5.9, 10 points), “nodule in nodule architecture” (OR=3.5, 7 points), “non-smooth tumor margin” (OR=1.6, 3 points) and “nonperipheral washout” (OR=0.6, -3 points). The optimal threshold of scoring system was 5.5 points, with AUC 0.75 and 0.73 on the training set and independent external validation sets, respectively. Prognosis after hepatic resection was worse in stem cell phenotype HCC patients, the poorer recurrence-free survival and overall survival were detected in those patients with pathologically confirmed or model predicted stem cell phenotype HCC.
Conclusion: Based on the three significant enhancement MRI features, we developed an easy-to-use and noninvasive risk score model which could accurately predict stem cell phenotype HCC, and revealed the patients with pathologically confirmed or model predicted stem cell phenotype HCC have worse prognosis, which may help improve personalized treatment decision making.
Acknowledgements
This work would thanks to funding by the National Natural Science Foundation of China (Grant No. 82101997, 81971571) and the Science and Technology Department of Sichuan Province (Grant No. 2022YFS0071, 2021YFS0021, 2021YFS0141).References
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