Leyao Wang1, Sicong Wang2, Xiaohong Ma1, and Xinming Zhao1
1National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2GE healthcare, MR Research China, Beijing, China
Synopsis
Keywords: Liver, Liver
Motivation: To explore the prognostic parameters related to microvascular invasion (MVI)-negative HCC patients.
Goal(s): The aim of this study was to establish a model for predicting the prognosis of patients with MVI-negative HCC based on qualitative and quantitative analyses of Gd-EOB-DTPA MRI.
Approach: Totally, 122 patients were retrospectively enrolled. Multivariate logistic regression analysis was performed to identify significant clinical parameters, and quantitative and qualitative MRI parameters associated with prognosis.
Results: Multivariate analysis showed that lower RER, HBP hypointensity without APHE, LI-RADS category, mild-moderate T2 hyperintensity, and higher AST levels were risk factors associated with prognosis. The most appropriate threshold value for RER was 1.197.
Impact: The nomogram incorporated preoperative qualitative and quantitative parameters and laboratory indices, namely LI-RADS category, HBP hypointensity without APHE, lower RER, mild-moderate T2 hyperintensity, and higher AST levels, can be a reliable tool for predicting prognosis in patients with MVI-negative HCC.
Introduction
Microvascular invasion (MVI) is significant prognostic factor for HCC and is associated with early postoperative recurrence, poor recurrence-free survival (RFS), and a shortened overall survival time [1,2]. Nonetheless, in current clinical practice, many MVI-negative patients present with early postoperative recurrence and poor prognosis. There is evidence that certain imaging features based on HBP images, such as peritumoral hypointensity on HBP images and HBP hypointensity without APHE, can be employed as noninvasive risk factors to assess the aggressive biological behavior of malignancies [3,4,5]. However, few studies have systematically explored the correlation between prognosis and MRI features, including quantitative and qualitative parameters, in patients with MVI-negative HCC. The purpose of this study was to investigate the utility of prognosis prediction in patients with MVI-negative HCC using quantitative and qualitative Gd-EOB-DTPA MRI analyses combined with clinical parameters, and to evaluate the predictive performance of a model created using identified imaging and clinical features.Methods
Consecutive patients with MVI-negative HCC who underwent preoperative Gd-EOB-DTPA MRI between January 2015 and December 2019 were retrospectively enrolled. In total, 122 patients were randomly assigned to the training and validation groups at a ratio of 7:3. Two evaluators performed qualitative analysis to evaluate the presence or absence of LI-RADS version 2018 major features (non-rim APHE, non-peripheral washout, enhancing capsule, and tumor size), ancillary features (corona enhancement, restricted diffusion, mild-moderate T2 hyperintensity, HBP hypointensity, mosaic architecture, fat in mass, and blood products in mass), and the following non-LI-RADS imaging features: liver cirrhosis, peritumoral HBP hypointensity, HBP hypointensity without APHE, and non-smooth tumor margins. In addition, each evaluator assessed the LI-RADS category of each lesion (LR-M, or LR-4/5). Univariate and multivariate logistic regression analyses were performed to identify significant clinical parameters and MRI features, including quantitative and qualitative parameters associated with prognosis, which were incorporated into a predictive nomogram. The end point of this study was recurrence-free survival. Outcomes were compared between groups using the Kaplan–Meier method with the log-rank test.Results
During a median follow-up period of 58.86 months, 84 patients had not experienced recurrence (68.85%), 38 (31.15%) experienced recurrence, 22 experienced recurrence within 24 months, and 16 experienced recurrence after 24 months. The median follow-up period was 60.03 months (range, 4.20–99.97 months) in the training group and 56.26 months (range, 2.17–100.67 months) in the validation group, respectively. Multivariate analysis revealed that lower relative enhancement ratio (RER), hepatobiliary phase hypointensity without arterial phase hyperenhancement, Liver Imaging Reporting and Data System category, mild-moderate T2 hyperintensity, and higher aspartate aminotransferase levels were risk factors associated with prognosis and then incorporated into the prognostic model. C-indices for training and validation groups were 0.732 and 0.692, respectively. The most appropriate cut-off value for RER was 1.197. Patients with RER ≤ 1.197 had significantly higher postoperative recurrence rates than those with RER > 1.197 (p = 0.004).Conclusion
We constructed a simple and promising model for assessing the prognosis of patients with MVI-negative HCC by combining preoperative qualitative and quantitative parameters as well as laboratory indices. This model can help clinicians differentiate between patients at high and low risk of recurrence, and shorter follow-up interval and additional treatments should be recommended for patients at high risk of recurrence to prolong survival time. Acknowledgements
No acknowledgement found.References
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