Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2021 Oct;28(11):6782-6789. doi: 10.1245/s10434-021-09772-8. Epub 2021 Mar 9.
This study was designed to investigate the association between Liver Imaging Reporting and Data System (LI-RADS) category and recurrence of hepatocellular carcinoma (HCC) after primary liver transplantation (LT) within the Milan criteria.
This multicenter, retrospective study included 140 recipients who underwent living donor LT (LDLT) for treatment-naïve HCC and pretransplant contrast-enhanced magnetic resonance imaging (MRI) between 2009 and 2013. LI-RADS categories were assigned using LI-RADS version 2018. Recurrence-free survival (RFS) and associated factors were evaluated using Cox proportional hazards regression analysis, Kaplan-Meier analysis, and log-rank test. Histological grading and microvascular invasion (MVI) were analyzed on the pathologic examinations of explanted livers.
The overall 1-, 3-, 5-, and 7-year RFS rates were 95.6%, 92.6%, 90.2%, and 89.3%, respectively. In the multivariable analysis, independent predictors of recurrence included HCCs categorized as LR-M (hazard ratio [HR], 18.68; 95% confidence interval [CI], 5.79-60.23; P < 0.001) and the largest tumor size of ≥ 3 cm on MRI (HR, 4.18; 95% CI, 1.42-12.37; P = 0.010). The 5-year RFS rate was significantly lower in patients with HCCs categorized as LR-M than in those with HCCs categorized as LR-5 or 4 (LR-5/4) (36.9% vs. 95.8%, respectively; P < 0.001). HCCs categorized as LR-M exhibited significantly more MVI than HCCs categorized as LR-5/4 (57.1% vs. 17.5%, respectively; P = 0.002).
Patients with HCCs categorized as LR-M using LI-RADS version 2018 may have a worse prognosis after primary LT within the Milan criteria than those with HCCs categorized as LR-5/4.
本研究旨在探讨 Liver Imaging Reporting and Data System (LI-RADS) 分类与米兰标准内原发性肝移植 (LT) 后肝细胞癌 (HCC) 复发之间的关系。
本多中心回顾性研究纳入了 140 例接受亲体肝移植 (LDLT) 治疗、无治疗 HCC 且移植前 2009 年至 2013 年期间行对比增强磁共振成像 (MRI) 的患者。采用 LI-RADS 版本 2018 对 LI-RADS 类别进行赋值。采用 Cox 比例风险回归分析、Kaplan-Meier 分析和对数秩检验评估无复发生存率 (RFS) 和相关因素。对切除的肝脏进行组织学分级和微血管侵犯 (MVI) 分析。
总体 1、3、5 和 7 年 RFS 率分别为 95.6%、92.6%、90.2%和 89.3%。多变量分析显示，复发的独立预测因素包括 MRI 上 HCC 类别为 LR-M（危险比 [HR]，18.68；95%置信区间 [CI]，5.79-60.23；P<0.001）和最大肿瘤直径≥3 cm（HR，4.18；95%CI，1.42-12.37；P=0.010）。LR-M 类 HCC 患者的 5 年 RFS 率明显低于 LR-5/4 类 HCC 患者（分别为 36.9%和 95.8%，P<0.001）。LR-M 类 HCC 的 MVI 明显多于 LR-5/4 类 HCC（分别为 57.1%和 17.5%，P=0.002）。
采用 LI-RADS 版本 2018 对 HCC 进行分类为 LR-M 的患者在米兰标准内接受原发性 LT 后的预后可能比分类为 LR-5/4 的患者更差。
