确定米兰标准的最佳影像学标准和方式，以预测局部治疗后移植后 HCC 复发的风险。

Optimal imaging criteria and modality to determine Milan criteria for the prediction of post-transplant HCC recurrence after locoregional treatment.

机构信息

Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.

Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.

出版信息

Eur Radiol. 2023 Jan;33(1):501-511. doi: 10.1007/s00330-022-08977-z. Epub 2022 Jul 12.

DOI:10.1007/s00330-022-08977-z

PMID:35821427

Abstract

OBJECTIVES

We aimed to investigate the optimal radiologic method to determine Milan criteria (MC) for the prediction of recurrence in patients who underwent locoregional treatment (LRT) for hepatocellular carcinoma (HCC) and subsequent liver transplantation (LT).

METHODS

This retrospective study included 121 HCC patients who underwent LRT and had both liver dynamic CT and MRI. They were classified with MC using four cross combinations of two imaging modalities (CT and MRI) and two diagnostic criteria (modified Response Evaluation Criteria in Solid Tumors [mRECIST] and Liver Imaging Reporting and Data System treatment response algorithm [LI-RADS TRA]). Competing risk regression was performed to analyze the time to recurrence after LT. The predictive abilities of the four methods for recurrence were evaluated using the time-dependent area under the curve (AUC).

RESULTS

Competing risk regression analyses found that beyond MC determined by MRI with mRECIST was independently associated with recurrence (hazard ratio, 6.926; p = 0.001). With mRECIST, MRI showed significantly higher AUCs than CT at 3 years and 5 years after LT (0.597 vs. 0.756, p = 0.012 at 3 years; and 0.588 vs. 0.733, p = 0.024 at 5 years). Using the pathologic reference standard, MRI with LI-RADS TRA showed higher sensitivity (61.5%) than CT with LI-RADS TRA (30.8%, p < 0.001) or MRI with mRECIST (38.5%, p < 0.001).

CONCLUSIONS

MRI with mRECIST was the optimal radiologic method to determine MC for the prediction of post-LT recurrence in HCC patients with prior LRT.

KEY POINTS

• MRI with modified RECIST (mRECIST) is the optimal preoperative method to determine Milan criteria for the prediction of post-transplant HCC recurrence in patients with prior locoregional treatment. • With mRECIST, MRI was better than CT for the prediction of post-transplant recurrence.

摘要

目的

本研究旨在探讨用于预测接受局部区域治疗（LRT）的肝细胞癌（HCC）患者米兰标准（MC）的最佳影像学方法，这些患者随后接受了肝移植（LT）。

方法

本回顾性研究纳入了 121 例接受 LRT 并同时进行了肝脏动态 CT 和 MRI 的 HCC 患者。使用两种成像方式（CT 和 MRI）和两种诊断标准（改良实体瘤反应评估标准 [mRECIST] 和肝脏成像报告和数据系统治疗反应算法 [LI-RADS TRA]）的四种交叉组合对患者进行 MC 分类。采用竞争风险回归分析 LT 后复发的时间。使用时间依赖性曲线下面积（AUC）评估四种方法对复发的预测能力。

结果

竞争风险回归分析发现，MRI 联合 mRECIST 确定的 MC 是 LT 后复发的独立预测因素（风险比，6.926；p = 0.001）。使用 mRECIST 时，MRI 在 LT 后 3 年和 5 年的 AUC 显著高于 CT（3 年时 0.597 比 0.756，p = 0.012；5 年时 0.588 比 0.733，p = 0.024）。使用病理参考标准，MRI 联合 LI-RADS TRA 的敏感性（61.5%）显著高于 MRI 联合 mRECIST（38.5%，p < 0.001）或 CT 联合 LI-RADS TRA（30.8%，p < 0.001）。