From the Departments of Radiology (Z.F., H.L., H.Z., Y.J., Q.L., W.W., P.R.) and Pathology (Q.C.), The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha 410013, China.
Radiology. 2021 Jul;300(1):219-229. doi: 10.1148/radiol.2021203614. Epub 2021 May 11.
Background Macrotrabecular-massive (MTM) subtype and vessels encapsulating tumor clusters (VETC) pattern of hepatocellular carcinoma (HCC) are associated with unfavorable prognosis. Purpose To estimate the potential of preoperative CT in the prediction of MTM subtype and VETC pattern. Materials and Methods Patients who underwent surgical resection or liver transplant and preoperative CT for HCC between January 2015 and June 2018 were retrospectively included in the primary cohort. CT imaging features were evaluated by two radiologists. Predictors associated with the MTM subtype or VETC pattern were determined by using logistic regression analyses and the performance was tested in a validation cohort. Prognostic factors associated with early recurrence after surgical resection were identified by using Cox regression analyses. Results The primary cohort included 170 patients (median age, 55 years; interquartile range, 48-63 years; 152 men). Serum α-fetoprotein level higher than 100 ng/mL (odds ratio [OR], 4.3; 95% CI: 2.1, 9.2; < .001), intratumor necrosis (OR, 5.2; 95% CI: 2.5, 11.0; < .001), and intratumor hemorrhage (OR, 5.4; 95% CI: 1.3, 23.3; = .02) were independent predictors for MTM subtype, whereas tumor size greater than 5 cm (OR, 3.8; 95% CI: 1.7, 8.1; = .001) and intratumor necrosis (OR, 2.1; 95% CI: 1.0, 4.4; = .045) were independent predictors for VETC pattern. These features were used for the construction of ANH and SN scores (where A is α-fetoprotein level, N is necrosis, H is hemorrhage, and S is size), respectively, which showed comparable prediction performance in the primary and validation cohorts. Preoperative high ANH and high SN phenotype (hazard ratio, 1.9; 95% CI: 1.2, 3.0; = .01) was independently associated with early recurrence after surgical resection. Conclusion Preoperative CT features could be used for the characterization of macrotrabecular-massive subtype and vessels that encapsulate tumor clusters pattern and were of prognostic significance for early recurrence in patients with hepatocellular carcinoma. See also the editorial by Yoon and Kim in this issue. Published under a CC BY 4.0 license.
肝细胞癌（HCC）的大巢状-巨梁型（MTM）亚型和包裹肿瘤簇的血管（VETC）模式与不良预后相关。目的：评估术前 CT 在预测 MTM 亚型和 VETC 模式中的潜力。材料与方法：回顾性纳入 2015 年 1 月至 2018 年 6 月期间接受 HCC 手术切除或肝移植且术前接受 CT 检查的患者。由两名放射科医生评估 CT 成像特征。使用逻辑回归分析确定与 MTM 亚型或 VETC 模式相关的预测因素，并在验证队列中进行测试。使用 Cox 回归分析确定与手术切除后早期复发相关的预后因素。结果：主要队列包括 170 名患者（中位年龄为 55 岁；四分位间距为 48-63 岁；152 名男性）。血清甲胎蛋白水平高于 100ng/ml（比值比[OR]，4.3；95%CI：2.1，9.2；<.001）、肿瘤内坏死（OR，5.2；95%CI：2.5，11.0；<.001）和肿瘤内出血（OR，5.4；95%CI：1.3，23.3；=.02）是 MTM 亚型的独立预测因素，而肿瘤直径大于 5cm（OR，3.8；95%CI：1.7，8.1；=.001）和肿瘤内坏死（OR，2.1；95%CI：1.0，4.4；=.045）是 VETC 模式的独立预测因素。这些特征分别用于构建 ANH 和 SN 评分（其中 A 是甲胎蛋白水平，N 是坏死，H 是出血，S 是大小），在主要和验证队列中均显示出可比的预测性能。术前高 ANH 和高 SN 表型（风险比，1.9；95%CI：1.2，3.0；=.01）与手术切除后早期复发独立相关。结论：术前 CT 特征可用于大巢状-巨梁型亚型和包裹肿瘤簇的血管的特征描述，对 HCC 患者的早期复发具有预后意义。另见本期 Yoon 和 Kim 的述评。在 CC BY 4.0 许可下发布。
