LI-RADS 类别与小单发 HCC 的治疗结果相关：手术切除与射频消融。
LI-RADS category is associated with treatment outcomes of small single HCC: surgical resection vs. radiofrequency ablation.
机构信息
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea.
出版信息
Eur Radiol. 2024 Jan;34(1):525-537. doi: 10.1007/s00330-023-09998-y. Epub 2023 Aug 1.
OBJECTIVES
To assess whether the Liver Imaging Reporting and Data System (LI-RADS) category is associated with the treatment outcomes of small single hepatocellular carcinoma (HCC) after surgical resection (SR) and radiofrequency ablation (RFA).
METHODS
This retrospective study included 357 patients who underwent SR (n = 209) or RFA (n = 148) for a single HCC of ≤ 3 cm between 2014 and 2016. LI-RADS categories were assigned. Overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP) rates after treatment were compared according to the LI-RADS category (LR-4/5 vs. LR-M) before and after propensity score matching (PSM). Prognostic factors for treatment outcomes were assessed.
RESULTS
In total, 357 patients (mean age, 59 years; men, 272) with 357 HCCs (294 LR-4/5 and 63 LR-M) were included. After PSM (n = 78 in each treatment group), there were 10 and 11 LR-M HCCs in the SR and RFA group, respectively. There were no significant differences in OS or RFS. However, SR provided a lower 5-year LTP rate than RFA (1.4% vs. 14.9%, p = 0.001). SR provided a lower 5-year LTP rate than RFA for LR-M HCCs (0% vs. 34.4%, p = 0.062) and LR-4/5 HCCs (1.5% vs. 12.0%, p = 0.008). The LI-RADS category was the sole risk factor associated with poor OS (hazard ratio [HR] 3.79, p = 0.004), RFS (HR 2.12; p = 0.001), and LTP (HR 2.89; p = 0.032).
CONCLUSION
LI-RADS classification is associated with the treatment outcome of HCC, supporting favorable outcomes of SR over RFA for LTP, especially for HCCs categorized as LR-M.
CLINICAL RELEVANCE STATEMENT
Liver Imaging Reporting and Data System category has a potential prognostic role, supporting favorable outcomes of surgical resection over radiofrequency ablation for local tumor progression, especially for hepatocellular carcinoma categorized as LR-M.
KEY POINTS
• SR provided a lower 5-year LTP rate than RFA for HCCs categorized as LR-M (0% vs. 34.4%, p = 0.062) and HCCs categorized as LR-4/5 (1.5% vs. 12.0%, p = 0.008). • There is a steeply increased risk of LTP within 1 year after RFA for LR-M HCCs, compared to SR. • The LI-RADS category was the sole risk factor associated with poor OS (HR 3.79, p = 0.004), RFS (HR 2.12; p = 0.001), and LTP (HR 2.89; p = 0.032) in patients with HCC of ≤ 3 cm treated with SR or RFA.
目的
评估肝脏成像报告和数据系统（LI-RADS）分类是否与手术切除（SR）和射频消融（RFA）后小单发肝细胞癌（HCC）的治疗结果相关。
方法
本回顾性研究纳入了 2014 年至 2016 年间接受单发 HCC 最大直径≤3cm 的 SR（n=209）或 RFA（n=148）治疗的 357 例患者。分配 LI-RADS 类别。在倾向评分匹配（PSM）前后，根据 LI-RADS 类别（LR-4/5 与 LR-M）比较治疗后总生存率（OS）、无复发生存率（RFS）和局部肿瘤进展（LTP）率。评估治疗结果的预后因素。
结果
共纳入 357 例患者（平均年龄 59 岁；男性 272 例）和 357 个 HCC（294 个 LR-4/5 和 63 个 LR-M）。PSM 后（每组 n=78），SR 和 RFA 组中分别有 10 个和 11 个 LR-M HCC。OS 或 RFS 无显著差异。然而，SR 提供的 5 年 LTP 率低于 RFA（1.4%与 14.9%，p=0.001）。对于 LR-M HCC（0%与 34.4%，p=0.062）和 LR-4/5 HCC（1.5%与 12.0%，p=0.008），SR 提供的 5 年 LTP 率低于 RFA。LI-RADS 类别是与不良 OS（危险比 [HR] 3.79，p=0.004）、RFS（HR 2.12；p=0.001）和 LTP（HR 2.89；p=0.032）相关的唯一危险因素。
结论
LI-RADS 分类与 HCC 的治疗结果相关，支持 SR 优于 RFA 治疗 LTP，尤其是对于 LR-M 分类的 HCC。
临床相关性声明
LI-RADS 分类具有潜在的预后作用，支持 SR 优于 RFA 治疗局部肿瘤进展，尤其是对于 LR-M 分类的 HCC。
关键点
对于 LR-M HCC（0%与 34.4%，p=0.062）和 HCC 分类为 LR-4/5（1.5%与 12.0%，p=0.008），SR 提供的 5 年 LTP 率低于 RFA。
与 SR 相比，LR-M HCC 患者在 RFA 后 1 年内发生 LTP 的风险显著增加。
在接受 SR 或 RFA 治疗的最大直径≤3cm 的 HCC 患者中，LI-RADS 类别是与不良 OS（HR 3.79，p=0.004）、RFS（HR 2.12；p=0.001）和 LTP（HR 2.89；p=0.032）相关的唯一危险因素。
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