Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Surg Oncol. 2020 Sep;27(9):3344-3353. doi: 10.1245/s10434-020-08419-4. Epub 2020 Apr 3.
The surgical indication for non-hypervascular hypointense nodules (NHVN) detected incidentally on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) for classical hepatocellular carcinoma (HCC) is unknown. Our aim is to clarify the long-term outcomes in patients with this finding.
We reviewed the cases of 290 HCC patients, including 66 patients with NHVN, who underwent Gd-EOB-MRI prior to hepatectomy, between October 2008 and December 2017 at our center. We divided the patients into three groups: a no-NHVN group, a treated NHVN group, and an untreated NHVN group.
There was no significant difference in (RFS) or overall survival (OS) between the no-NHVN and untreated NHVN groups (p = 0.103 and 0.103, respectively). There was no significant difference between these two groups after propensity score matching. Multivariate analyses showed that microscopic intrahepatic metastases and the size of the main classical HCC, the target tumor, were independent prognostic factors of overall survival, but the presence of non-hypervascular hypointense nodules was not. There was no significant difference in RFS or OS between the treated NHVN and untreated NHVN groups (p = 0.158 and 0.109, respectively).
Non-hypervascular hypointense nodules detected incidentally on Gd-EOB-MRI associated with targeted hypervascular HCC did not reflect prognosis of HCC after hepatectomy. Surgical procedures for classical enhancing HCC may be performed even if non-hypervascular hypointense nodules adjacent to the targeted HCC cannot be removed completely.
在钆乙氧基苯甲基二乙三胺五乙酸增强磁共振成像（Gd-EOB-MRI）检测到的经典肝细胞癌（HCC）的非富血供低信号结节（NHVN）的手术适应证尚不清楚。我们的目的是明确具有此发现的患者的长期预后。
我们回顾了 2008 年 10 月至 2017 年 12 月期间在我们中心接受 Gd-EOB-MRI 检查并接受肝切除术的 290 例 HCC 患者（包括 66 例 NHVN 患者）的病例。我们将患者分为三组：无 NHVN 组、治疗 NHVN 组和未治疗 NHVN 组。
无 NHVN 组和未治疗 NHVN 组之间（RFS）或总生存期（OS）无显著差异（分别为 p=0.103 和 0.103）。在倾向评分匹配后，这两组之间没有显著差异。多变量分析显示，显微镜下肝内转移和主要经典 HCC（靶肿瘤）的大小是总生存的独立预后因素，但非富血供低信号结节的存在不是。治疗 NHVN 组和未治疗 NHVN 组之间的 RFS 或 OS 无显著差异（分别为 p=0.158 和 0.109）。
Gd-EOB-MRI 检测到的与靶向富血供 HCC 相关的偶然非富血供低信号结节并不能反映肝切除术后 HCC 的预后。即使不能完全切除靶向 HCC 旁的非富血供低信号结节，也可以进行经典增强 HCC 的手术程序。
