Zhang Laizhu, Mai Xiaoli, Li Binghua, Li Huan, Liu Qi, Li Yunzheng, Zhu Yican, Jiang Xiang, Wang Weihong, Qiao Chu, Chen Jun, Xu Chun, Chen Jun, Yu Decai
Division of Hepatobiliary and Transplantation Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
Eur Radiol. 2025 Jun;35(6):3144-3157. doi: 10.1007/s00330-024-11151-2. Epub 2024 Nov 22.
This study explored the clinical prognosis and lipidomics of hepatitis B virus steatohepatitic hepatocellular carcinoma (HBV-SHHCC) and aimed to identify a noninvasive and convenient method to diagnose this phenotype and guide treatment using MRI.
A total of 433 HBV-infected HCC patients were enrolled in this retrospective study. Survival data were analyzed using Cox regression analyses, and lipidomics was used to study HCC tissue composition. Logistic regression identified an independent predictor for HBV-SHHCC, and receiver-operating characteristic (ROC) analysis verified its discrimination.
HBV-SHHCC patients had longer disease-free survival (DFS, p < 0.0001) and overall survival (OS) time (p = 0.00097). Compared with common HCC (cHCC), SHHCC was associated with significantly higher mean triacylglyceride (p = 0.010) and diacylglyceride contents (p = 0.002) in tumor tissues. Fat fraction (FF) was linearly correlated with lipid composition and fatty acid degradation (FAD) subtype, which could help in treatment options for HCC. The univariate and multivariate logistic regression indicated FF (p < 0.001) as an independent predictor for diagnosing this phenotype. ROC analysis confirmed excellent discrimination (area under the curve (AUC), 0.914; sensitivity, 92.3%; specificity, 78.7.0%). After using the optimal cutoff point, the DFS time of patients with SHHCC stratified by FF was significantly higher than that of patients with cHCC.
The biological behavior and prognosis of HBV-SHHCC were better than those of other types. FF is a valuable tool for the clinical diagnosis of SHHCC, prognosis prediction, and treatment guidance in patients with HCC.
Question Can the diagnosis of steatohepatitic hepatocellular carcinoma (SHHCC) be made noninvasively? Findings Fat fraction (FF) correlated with lipid composition and could be used to diagnose SHHCC with an AUC of 0.914, sensitivity of 92.3%, and specificity of 78.7%. Clinical relevance MRI-based FF could be used to diagnose HBV-related SHHCC, indicate prognosis, and guide the clinical treatment of patients with HCC.
本研究探讨乙型肝炎病毒脂肪性肝炎相关肝细胞癌（HBV-SHHCC）的临床预后和脂质组学，并旨在确定一种非侵入性且便捷的方法，利用磁共振成像（MRI）诊断该表型并指导治疗。
本回顾性研究共纳入433例HBV感染的肝癌患者。采用Cox回归分析生存数据，脂质组学用于研究肝癌组织成分。逻辑回归确定HBV-SHHCC的独立预测因子，受试者工作特征（ROC）分析验证其判别能力。
HBV-SHHCC患者的无病生存期（DFS，p < 0.0001）和总生存期（OS）时间更长（p = 0.00097）。与普通肝癌（cHCC）相比，SHHCC肿瘤组织中的平均甘油三酯（p = 0.010）和甘油二酯含量显著更高（p = 0.002）。脂肪分数（FF）与脂质组成和脂肪酸降解（FAD）亚型呈线性相关，这有助于肝癌的治疗选择。单因素和多因素逻辑回归表明FF（p < 0.001）是诊断该表型的独立预测因子。ROC分析证实具有出色的判别能力（曲线下面积（AUC）为0.914；敏感性为92.3%；特异性为78.7%）。使用最佳截断点后，按FF分层的SHHCC患者的DFS时间显著高于cHCC患者。
HBV-SHHCC的生物学行为和预后优于其他类型。FF是临床诊断SHHCC、预测预后及指导肝癌患者治疗的有价值工具。
问题 脂肪性肝炎相关肝细胞癌（SHHCC）能否进行非侵入性诊断？ 发现 脂肪分数（FF）与脂质组成相关，可用于诊断SHHCC，AUC为0.914，敏感性为92.3%，特异性为78.7%。 临床意义 基于MRI的FF可用于诊断HBV相关的SHHCC、提示预后并指导肝癌患者的临床治疗。
