Meng Xiang-Pan, Tang Tian-Yu, Zhou Yongping, Xia Cong, Xia Tianyi, Shi Yibing, Long Xueying, Liang Yun, Xiao Wenbo, Wang Yuan-Cheng, Fang Xiangming, Ju Shenghong
Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China.
Department of Hepatobiliary Surgery, Jiangnan University Medical Center, Wuxi, China.
JHEP Rep. 2023 Jun 1;5(9):100806. doi: 10.1016/j.jhepr.2023.100806. eCollection 2023 Sep.
BACKGROUND & AIMS: Distinct vascular patterns, including microvascular invasion (MVI) and vessels encapsulating tumour clusters (VETC), are associated with poor outcomes of hepatocellular carcinoma (HCC). Imaging surrogates of these vascular patterns potentially help to predict post-resection recurrence. Herein, a prognostic model integrating imaging-based surrogates of these distinct vascular patterns was developed to predict postoperative recurrence-free survival (RFS) in patients with HCC.
Clinico-radiological data of 1,285 patients with HCC from China undergoing surgical resection were retrospectively enrolled from seven medical centres between 2014 and 2020. A prognostic model using clinical data and imaging-based surrogates of MVI and VETC patterns was developed (n = 297) and externally validated (n = 373) to predict RFS. The surrogates (i.e. MVI and VETC scores) were individually built from preoperative computed tomography using two independent cohorts (n = 360 and 255). Whether the model's stratification was associated with postoperative recurrence following anatomic resection was also evaluated.
The MVI and VETC scores demonstrated effective performance in their respective training and validation cohorts (AUC: 0.851-0.883 for MVI and 0.834-0.844 for VETC). The prognostic model incorporating serum alpha-foetoprotein, tumour multiplicity, MVI score, and VETC score achieved a C-index of 0.748-0.764 for the developing and external validation cohorts and generated three prognostically distinct strata. For patients at model-predicted medium risk, anatomic resection was associated with improved RFS ( <0.05). By contrast, anatomic resection had no impact on RFS in patients at model-predicted low or high risk (both >0.05).
The proposed model integrating imaging-based surrogates of distinct vascular patterns enabled accurate prediction for RFS. It can potentially be used to identify HCC surgical candidates who may benefit from anatomic resection.
MVI and VETC are distinct vascular patterns of HCC associated with aggressive biological behaviour and poor outcomes. Our multicentre study provided a model incorporating imaging-based surrogates of these patterns for preoperatively predicting RFS. The proposed model, which uses imaging detection to estimate the risk of MVI and VETC, offers an opportunity to help shed light on the association between tumour aggressiveness and prognosis and to support the selection of the appropriate type of surgical resection.
不同的血管模式，包括微血管侵犯（MVI）和包绕肿瘤结节的血管（VETC），与肝细胞癌（HCC）的不良预后相关。这些血管模式的影像学替代指标可能有助于预测切除术后的复发情况。在此，我们建立了一个整合这些不同血管模式的基于影像学替代指标的预后模型，以预测HCC患者术后无复发生存期（RFS）。
回顾性纳入2014年至2020年间来自中国7个医学中心的1285例行手术切除的HCC患者的临床放射学数据。建立一个使用临床数据以及MVI和VETC模式的基于影像学替代指标的预后模型（n = 297）并进行外部验证（n = 373）以预测RFS。替代指标（即MVI和VETC评分）分别使用两个独立队列（n = 360和255）从术前计算机断层扫描中构建。还评估了该模型的分层是否与解剖切除术后的复发相关。
MVI和VETC评分在各自的训练和验证队列中表现出有效性能（MVI的AUC：0.851 - 0.883，VETC的AUC：0.834 - 0.844）。纳入血清甲胎蛋白、肿瘤多灶性、MVI评分和VETC评分的预后模型在开发队列和外部验证队列中的C指数为0.748 - 0.764，并产生了三个预后明显不同的分层。对于模型预测为中度风险的患者，解剖切除与改善的RFS相关（P <0.05）。相比之下，解剖切除对模型预测为低风险或高风险的患者的RFS没有影响（两者P均>0.05）。
所提出的整合不同血管模式的基于影像学替代指标的模型能够准确预测RFS。它可能可用于识别可能从解剖切除中获益的HCC手术候选者。
MVI和VETC是HCC的不同血管模式，与侵袭性生物学行为和不良预后相关。我们的多中心研究提供了一个纳入这些模式的基于影像学替代指标的模型，用于术前预测RFS。所提出的模型利用影像学检测来估计MVI和VETC的风险，提供了一个机会来帮助阐明肿瘤侵袭性与预后之间的关联，并支持选择合适的手术切除类型。
