Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Eur Radiol. 2021 May;31(5):3405-3416. doi: 10.1007/s00330-020-07419-y. Epub 2020 Nov 4.
The primary aim of this study was to determine the clinical and histopathological prognostic factors for patients who underwent surgical resection of multiple hepatocellular carcinomas (HCCs) of multicentric occurrence. The secondary aim of this study was to evaluate whether specific imaging-related factors, including arterial phase hyperenhancement (APHE) and the LI-RADS category of each lesion on gadoxetic acid-enhanced MRI, would provide additional prognostic information about multicentric HCCs.
In this retrospective study, 54 patients with 120 multicentric HCCs were diagnosed by surgical resection at a single tertiary hospital between 2009 and 2014. Two independent readers evaluated patients' preoperative gadoxetic acid-enhanced MR images and recorded APHE and LI-RADS category for each HCC, with discrepancies resolved through consensus sessions if necessary. Potential clinicopathologic and imaging parameters for predicting disease-free survival (DFS) and overall survival (OS) were analyzed using Cox regression analysis.
Presence of microvascular invasion (MVI) (p = 0.003) and of three or more HCCs (p = 0.013) were both independent predictors of a shorter DFS. Patients with concurrent MVI and three or more HCCs had the shortest DFS. MVI was the only statistically significant parameter (p = 0.023) predicting OS. The number of HCCs with APHE or LR-5/M category was not associated with survival.
Presence of MVI and of three or more HCCs were associated with poorer outcomes after surgical resection of multicentric HCCs. Imaging parameters on gadoxetic acid-enhanced MRI such as APHE or LI-RADS category were not associated with postsurgical outcomes.
• Patients with three or more hepatocellular carcinomas showed worse disease-free survival than those with two hepatocellular carcinomas after surgical resection. • Microvascular invasion was the only significant factor to affect both the disease-free and overall survivals of patients after surgical resection of multicentric hepatocellular carcinomas. • Preoperative MRI findings related to multicentric hepatocellular carcinomas such as arterial phase hyperenhancement and LI-RADS category of lesions did not provide significant prognostic information.
本研究的主要目的是确定接受多中心发生的多个肝细胞癌（HCC）手术切除的患者的临床和组织病理学预后因素。本研究的次要目的是评估包括动脉期强化（APHE）和钆塞酸增强 MRI 上每个病变的 LI-RADS 类别在内的特定影像学相关因素是否会为多中心 HCC 提供额外的预后信息。
在这项回顾性研究中，2009 年至 2014 年期间，在一家三级医院通过手术切除诊断了 54 例 120 个多中心 HCC 患者。两名独立的读者评估了患者的术前钆塞酸增强 MRI 图像，并记录了每个 HCC 的 APHE 和 LI-RADS 类别，如果有必要，则通过共识会议解决差异。使用 Cox 回归分析分析预测无病生存（DFS）和总生存（OS）的潜在临床病理和影像学参数。
微血管侵犯（MVI）的存在（p=0.003）和三个或更多 HCC 的存在（p=0.013）均是 DFS 较短的独立预测因素。同时存在 MVI 和三个或更多 HCC 的患者的 DFS 最短。MVI 是唯一具有统计学意义的参数（p=0.023），可预测 OS。具有 APHE 或 LR-5/M 类别的 HCC 数量与生存无关。
MVI 的存在和三个或更多 HCC 的存在与多中心 HCC 手术后的不良结果相关。增强 MRI 上的影像学参数，如 APHE 或 LI-RADS 类别，与手术后结果无关。
与接受两个 HCC 切除的患者相比，接受三个或更多 HCC 切除的患者在手术后的无病生存率较低。
MVI 是影响多中心 HCC 手术后患者无病和总生存率的唯一显著因素。
与多中心 HCC 相关的术前 MRI 发现，如动脉期强化和病变的 LI-RADS 类别，并未提供有意义的预后信息。
