From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.).
Radiology. 2020 May;295(2):361-372. doi: 10.1148/radiol.2020191790. Epub 2020 Mar 17.
Background Hepatocellular adenomas (HCAs) are rare benign liver tumors. Guidelines recommend continued surveillance of patients diagnosed with HCAs, but these guidelines are mainly based on small studies or expert opinion. Purpose To analyze the long-term evolution of HCAs, including solitary and multiple lesions, and to identify predictive features of progression with MRI. Materials and Methods In a retrospective study, patients diagnosed with pathologically proven solitary or multiple HCAs between January 2004 and December 2015 were included; β-catenin-mutated HCAs and HCAs with foci of malignancy were considered to be at risk for progression. MRI examinations were analyzed, and tumor evolution was evaluated by using Response Evaluation Criteria in Solid Tumors, version 1.1. Student Mann-Whitney, χ, Fisher exact, and McNemar tests were used, as appropriate. Results In total, 118 patients (mean age, 40 years ± 10 [standard deviation]; 108 women) were evaluated, including 41 with a solitary HCA (mean age, 40 years ± 14; 36 women) and 77 with multiple HCAs (mean age, 40 years ± 10; 72 women). At a median follow-up of 5 years, 37 of 41 (90%) patients with a solitary HCA and 55 of 77 (71%) patients with multiple HCAs showed stable or regressive disease. After resection of solitary HCAs, new lesions appeared in only two of 29 (7%) patients, both of whom had HCAs at risk of progression. In patients with multiple HCAs, hepatocyte nuclear factor 1α-inactivated HCAs showed a higher rate of progression compared with inflammatory HCAs (11 of 26 [42%] vs seven of 37 [19%], = .04) despite lower use (28 of 32 patients [88%] vs 45 of 45 patients [100%]; = .03) and shorter duration (mean, 12.0 years ± 7.5 vs 19.2 years ± 9.2; = .001) of oral contraceptive intake. Conclusion Long-term MRI follow-up showed that 78% of hepatocellular adenomas had long-term stability or regression. After resection of solitary hepatocellular adenomas, new lesions occurred only in hepatocellular adenomas at risk of progression. Patients with multiple hepatocellular adenomas were more likely to show progressive disease, with hepatic nuclear factor 1α-inactivated hepatocellular adenomas being the most common subtype showing progression. © RSNA, 2020
背景 肝细胞腺瘤（HCA）是罕见的良性肝肿瘤。指南建议对诊断为 HCA 的患者进行持续监测，但这些指南主要基于小型研究或专家意见。目的 分析 HCA（包括单发和多发病变）的长期演变，并确定 MRI 预测进展的特征。材料与方法 在这项回顾性研究中，纳入了 2004 年 1 月至 2015 年 12 月期间经病理证实为单发或多发 HCA 的患者；β-连环蛋白突变型 HCA 和具有恶性灶的 HCA 被认为有进展风险。分析 MRI 检查结果，并采用实体瘤反应评价标准 1.1 版评估肿瘤演变。适当采用学生 t 检验、Mann-Whitney 检验、χ2 检验、Fisher 确切概率法和 McNemar 检验。结果 共评估了 118 例患者（平均年龄 40 岁±10[标准差]；108 例女性），其中 41 例为单发 HCA（平均年龄 40 岁±14；36 例女性），77 例为多发 HCA（平均年龄 40 岁±10；72 例女性）。中位随访 5 年时，41 例单发 HCA 患者中有 37 例（90%）和 77 例多发 HCA 患者中有 55 例（71%）表现为稳定或退行性疾病。在单发 HCA 切除后，仅有 2 例（7%）于 29 例患者（均为有进展风险的 HCA）中出现新发病变。在多发 HCA 患者中，与炎症性 HCA 相比，肝细胞核因子 1α失活型 HCA 显示出更高的进展率（26 例中有 11 例[42%] vs 37 例中有 7 例[19%]， =.04），尽管其使用率较低（32 例中有 28 例[88%] vs 45 例中有 45 例[100%]； =.03），持续时间更短（平均 12.0 年±7.5 年 vs 19.2 年±9.2 年； =.001），接受口服避孕药治疗。结论 长期 MRI 随访显示，78%的肝细胞腺瘤具有长期稳定性或退行性。在单发 HCA 切除后，新发病变仅出现在有进展风险的 HCA 中。多发 HCA 患者更有可能出现进展性疾病，其中肝细胞核因子 1α失活型 HCA 是最常见的进展型亚型。©RSNA，2020
