From the Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France (S.M., A.G.P., R.K., L.B., M.D., F.P., V.T., H.K., A. Luciani); Faculté de Médecine, Université Paris Est Créteil, Créteil, France (S.M., G.A., A. Laurent, D.S., V.T., H.K., J.C., A. Luciani); INSERM IMRB, U 955, Team 18, Créteil, France (S.M., G.A., V.T., J.C., A. Luciani); Laboratoire des Signaux et Systèmes, Paris-Saclay University, Gif sur Yvette, France (A.T.); Hepatology Department, AP-HP, Henri Mondor University Hospital, Créteil, France (G.A., H.R.); Digestive Surgery Department, AP-HP, Henri Mondor University Hospital, Créteil, France (A. Laurent, D.S.); and Pathology Department, AP-HP, Henri Mondor University Hospital, Créteil, France (J.C.).
Radiology. 2020 Jun;295(3):562-571. doi: 10.1148/radiol.2020192230. Epub 2020 Mar 31.
Background The recently described "macrotrabecular-massive" (MTM) histologic subtype of hepatocellular carcinoma (HCC) (MTM-HCC) represents an aggressive form of HCC and is associated with poor survival. Purpose To investigate whether preoperative MRI can help identify MTM-HCCs in patients with HCC. Materials and Methods This retrospective study included patients with HCC treated with surgical resection between January 2008 and February 2018 and who underwent preoperative multiphase contrast material-enhanced MRI. Least absolute shrinkage and selection operator (LASSO)-penalized and multivariable logistic regression analyses were performed to identify clinical, biologic, and imaging features associated with the MTM-HCC subtype. Early recurrence (within 2 years) and overall recurrence were evaluated by using Kaplan-Meier analysis. Multivariable Cox regression analysis was performed to determine predictors of early and overall recurrence. Results One hundred fifty-two patients (median age, 64 years; interquartile range, 56-72 years; 126 men) with 152 HCCs were evaluated. Twenty-six of the 152 HCCs (17%) were MTM-HCCs. LASSO-penalized logistic regression analysis identified substantial necrosis, high serum α-fetoprotein (AFP) level (>100 ng/mL), and Barcelona Clinic Liver Cancer (BCLC) stage B or C as independent features associated with MTM-HCCs. At multivariable analysis, substantial necrosis (odds ratio = 32; 95% confidence interval [CI] = 8.9, 114; < .001), high serum AFP level (odds ratio = 4.4; 95% CI = 1.3, 16; = .02), and BCLC stage B or C (odds ratio = 4.2; 95% CI = 1.2, 15; = .03) were independent predictors of MTM-HCC subtype. Substantial necrosis helped identify 65% (17 of 26; 95% CI: 44%, 83%) of MTM-HCCs (sensitivity) with a specificity of 93% (117 of 126; 95% CI: 87%, 97%). In adjusted models, only the presence of satellite nodules was independently associated with both early (hazard ratio = 3.7; 95% CI: 1.5, 9.4; = .006) and overall (hazard ratio = 3.0; 95% CI: 1.3, 7.2; = .01) tumor recurrence. Conclusion At multiphase contrast-enhanced MRI, substantial necrosis helped identify macrotrabecular-massive hepatocellular carcinoma subtype with high specificity. © RSNA, 2020.
背景 最近描述的肝细胞癌（HCC）的“巨梁状大量”（MTM）组织学亚型（MTM-HCC）是 HCC 的一种侵袭性形式，与不良生存相关。目的 研究术前 MRI 是否有助于识别 HCC 患者中的 MTM-HCC。材料与方法 本回顾性研究纳入了 2008 年 1 月至 2018 年 2 月期间接受手术切除治疗且接受术前多期对比增强 MRI 的 HCC 患者。采用最小绝对收缩和选择算子（LASSO）惩罚和多变量逻辑回归分析，确定与 MTM-HCC 亚型相关的临床、生物学和影像学特征。采用 Kaplan-Meier 分析评估早期（2 年内）和总体复发情况。采用多变量 Cox 回归分析确定早期和总体复发的预测因素。结果 共评估了 152 例 HCC 患者（中位年龄，64 岁；四分位间距，5672 岁；126 例男性）的 152 个 HCC。152 个 HCC 中有 26 个（17%）为 MTM-HCC。LASSO 惩罚逻辑回归分析确定广泛坏死、高血清甲胎蛋白（AFP）水平（>100 ng/mL）和巴塞罗那临床肝癌（BCLC）分期 B 或 C 为与 MTM-HCC 相关的独立特征。多变量分析显示，广泛坏死（比值比=32；95%置信区间：8.9114；<.001）、高血清 AFP 水平（比值比=4.4；95%置信区间：1.316；=.02）和 BCLC 分期 B 或 C（比值比=4.2；95%置信区间：1.215；=.03）是 MTM-HCC 亚型的独立预测因素。广泛坏死有助于识别 65%（26 例中的 17 例；95%置信区间：44%83%）（敏感性），特异性为 93%（126 例中的 117 例；95%置信区间：87%97%）。在调整模型中，仅卫星结节的存在与早期（风险比=3.7；95%置信区间：1.59.4；=.006）和总体（风险比=3.0；95%置信区间：1.37.2；=.01）肿瘤复发均相关。结论 在多期对比增强 MRI 中，广泛坏死有助于以高特异性识别 MTM-HCC 亚型。
