From the Department of Radiology and Research Institute of Radiology (S.H.C., J.H.B., S.J.L., S.Y.K., H.J.W., Y.M.S., P.N.K.) and Department of Gastroenterology (Y.S.L.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
Radiology. 2018 May;287(2):515-524. doi: 10.1148/radiol.2018170748. Epub 2018 Feb 19.
Purpose To determine the outcomes after initial therapy in patients with chronic liver disease and retrospectively assigned Liver Imaging Reporting and Data System (LI-RADS; version 2014) category 4 (LR-4) and 5 (LR-5) nodules at gadoxetate disodium-enhanced MR imaging. Materials and Methods In this retrospective study, 260 patients with a single LR-4 (n = 132) or LR-5 (n = 128) nodule who were assigned a LI-RADS category were included. Patients were identified between January 2012 and December 2012, and were initially treated by resection, liver transplant, radiofrequency ablation (RFA), or transcatheter arterial chemoembolization (TACE) according to the Barcelona Clinic Liver Cancer staging system. Follow-up continued until August 31, 2016. The incidences of local tumor recurrence (ILRs) and distant tumor recurrence (IDRs) and recurrence-free survival (RFS) were compared between the LR-4 and LR-5 patients. For each category, ILRs, IDRs, and RFS were compared across the four treatments. Results LR-5 patients were more frequently treated by surgical resection than LR-4 patients (72.7% [93 of 128] vs 41.7% [55 of 132], respectively; P < .001), but less frequently treated by RFA (19.5% [25 of 128] vs 30.3% [40 of 132], respectively; P = .047) and TACE (6.3% [eight of 128] vs 22.0% [29 of 132], respectively; P < .001). ILRs and IDRs were not significantly different between LR-4 and LR-5 patients according to the type of treatment (0%-48.3% [14 of 29] vs 0%-25.0% [two of eight], P $ .423; 0%-55.2% [16 of 29] vs 0%-37.5% [three of eight], P $ .447, respectively). There was no difference in RFS between the two categories (36.3 months vs 41.7 months, respectively; P = .084). Liver transplant showed no local or distant tumor recurrence in either category. Resection showed higher RFS and lower ILR and IDR than RFA and TACE in both LR-4 and LR-5 patients. Conclusion Patients with LR-4 nodules had ILRs and IDRs similar to patients with LR-5 nodules when stratified by treatment type. RFS was also similar between patients with LR-4 and LR-5 nodules. Among the four initial treatments, liver transplant and resection showed better local tumor control, with longer RFS than RFA or TACE. RSNA, 2018 Online supplemental material is available for this article.
目的 旨在明确在慢性肝病患者中，初始治疗后（retrospectively assigned）的结果，这些患者的钆塞酸二钠增强磁共振成像（gadoxetate disodium-enhanced MR imaging）上的肝脏成像报告和数据系统（Liver Imaging Reporting and Data System，LI-RADS）分类为 4 类（LR-4）和 5 类（LR-5）结节。
材料与方法 在这项回顾性研究中，共纳入了 260 名单个 LR-4（n=132）或 LR-5（n=128）结节患者，这些患者的 LI-RADS 分类为 LR-4 或 LR-5。患者于 2012 年 1 月至 2012 年 12 月间被识别，并根据巴塞罗那临床肝癌分期系统（Barcelona Clinic Liver Cancer staging system）接受了肝切除术、肝移植、射频消融术（radiofrequency ablation，RFA）或经导管肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）等初始治疗。随访一直持续到 2016 年 8 月 31 日。比较了 LR-4 和 LR-5 患者的局部肿瘤复发（local tumor recurrence，ILR）和远处肿瘤复发（distant tumor recurrence，IDR）发生率以及无复发生存率（recurrence-free survival，RFS）。对于每个类别，比较了四种治疗方法的 ILR、IDR 和 RFS。
结果 LR-5 患者比 LR-4 患者更常接受肝切除术治疗（分别为 72.7%[93/128]和 41.7%[55/132]；P＜0.001），但较少接受 RFA（分别为 19.5%[25/128]和 30.3%[40/132]；P=0.047）和 TACE（分别为 6.3%[8/128]和 22.0%[29/132]；P＜0.001）。根据治疗类型，LR-4 和 LR-5 患者的 ILR 和 IDR 无显著差异（0%-48.3%[14/29]比 0%-25.0%[2/8]，P$0.423；0%-55.2%[16/29]比 0%-37.5%[3/8]，P$0.447）。两种分类的 RFS 无差异（分别为 36.3 个月和 41.7 个月；P=0.084）。肝移植在两种分类中均未出现局部或远处肿瘤复发。在 LR-4 和 LR-5 患者中，与 RFA 和 TACE 相比，肝切除术的 RFS 更高，ILR 和 IDR 更低。
结论 在按治疗类型分层时，LR-4 结节患者的 ILR 和 IDR 与 LR-5 结节患者相似。LR-4 和 LR-5 结节患者的 RFS 也相似。在四种初始治疗方法中，肝移植和肝切除术显示出更好的局部肿瘤控制效果，RFS 长于 RFA 或 TACE。
RSNA，2018 在线补充材料可在本文中获得。
