Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Eur Radiol. 2024 May;34(5):2974-2985. doi: 10.1007/s00330-023-10305-y. Epub 2023 Oct 18.
We aimed to compare Liver Imaging Reporting and Data System (LI-RADS) category 4/5 and category M (LR-M) of proliferative hepatocellular carcinomas (HCCs) in cirrhotic patients and evaluate their impacts on prognosis.
This retrospective multi-reader study included cirrhotic patients with single treatment-naïve HCC ≤ 5.0 cm who underwent contrast-enhanced CT, MRI, and subsequent hepatic resection within 2 months. The percentages of CT/MRI LR-4/5 and LR-M in proliferative and non-proliferative HCCs were compared. Univariable and multivariable Cox proportional hazards regression analyses were performed to assess the association of LI-RADS categories (LR-4/5 vs. LR-M) and pathologic classification (proliferative vs. non-proliferative) with overall survival (OS) and recurrence-free survival (RFS). Subgroups of patients with proliferative and non-proliferative HCCs were analyzed to compare OS and RFS between LR-4/5 and LR-M.
Of the 204 included patients, 38 were classified as having proliferative HCC. The percentages of LR-M were higher in proliferative than non-proliferative HCC on both CT (15.8% vs. 3.0%, p = 0.007) and MRI (26.3% vs. 9.6%, p = 0.016). Independent of pathologic classification, CT and MRI LR-M were significantly associated with poorer OS (hazard ratio (HR) = 4.58, p = 0.013, and HR = 6.45, p < 0.001) and RFS (HR = 3.66, p = 0.005, and HR = 6.44, p < 0.001) than LR-4/5. MRI LR-M was associated with significantly poorer OS (p ≤ 0.003) and RFS (p < 0.001) than MRI LR-4/5 in both proliferative and non-proliferative HCCs.
This multi-reader study showed that the percentages of LR-M were significantly higher in proliferative than non-proliferative HCCs. CT/MRI LR-M was significantly associated with poor OS and RFS, independent of the pathologic classification of proliferative versus non-proliferative HCCs.
CT and MRI LI-RADS category M can be clinically useful in predicting poor outcomes in patients with proliferative and non-proliferative hepatocellular carcinomas.
• The percentages of LR-M tumors on both CT and MRI were significantly higher in proliferative than non-proliferative hepatocellular carcinomas. • Independent of pathologic classification, CT/MRI LR-M categories were correlated with poor overall survival and recurrence-free survival. • Patients with both proliferative and non-proliferative hepatocellular carcinomas categorized as MRI LR-M had significantly poorer overall survival and recurrence-free survival than those categorized as MRI LR-4/5.
我们旨在比较肝硬化患者中肝脏成像报告和数据系统（LI-RADS）类别 4/5 和类别 M（LR-M）的增生性肝细胞癌（HCC），并评估它们对预后的影响。
本回顾性多读者研究纳入了单个治疗初治、直径≤5.0cm 的 HCC 且伴有肝硬化的患者，这些患者在 2 个月内接受了增强 CT、MRI 检查，并随后进行了肝切除术。比较 CT/MRI 中增生性和非增生性 HCC 的 LR-4/5 和 LR-M 的百分比。使用单变量和多变量 Cox 比例风险回归分析评估 LI-RADS 类别（LR-4/5 与 LR-M）和病理分类（增生性与非增生性）与总生存（OS）和无复发生存（RFS）的相关性。对增生性和非增生性 HCC 患者进行亚组分析，以比较 LR-4/5 和 LR-M 之间的 OS 和 RFS。
在 204 名纳入的患者中，有 38 名被归类为增生性 HCC。与非增生性 HCC 相比，CT（15.8%比 3.0%，p=0.007）和 MRI（26.3%比 9.6%，p=0.016）上 LR-M 的百分比在增生性 HCC 中更高。独立于病理分类，CT 和 MRI LR-M 与较差的 OS（风险比（HR）=4.58，p=0.013，和 HR=6.45，p<0.001）和 RFS（HR=3.66，p=0.005，和 HR=6.44，p<0.001）显著相关。与 LR-4/5 相比，MRI LR-M 与 OS（p≤0.003）和 RFS（p<0.001）显著较差相关。MRI LR-M 在增生性和非增生性 HCC 中均与显著较差的 OS（p≤0.003）和 RFS（p<0.001）相关。
本多读者研究表明，LR-M 的百分比在增生性 HCC 中显著高于非增生性 HCC。CT/MRI LR-M 与 OS 和 RFS 显著相关，独立于增生性与非增生性 HCC 的病理分类。
在增生性和非增生性肝细胞癌患者中，CT 和 MRI 的 LI-RADS 类别 M 可用于预测不良预后。
• CT 和 MRI 上 LR-M 肿瘤的百分比在增生性 HCC 中明显高于非增生性 HCC。• 独立于病理分类，CT/MRI LR-M 类别与总生存和无复发生存不良相关。• 被归类为 MRI LR-M 的增生性和非增生性 HCC 患者的总生存和无复发生存明显差于被归类为 MRI LR-4/5 的患者。
