Jang Hyeon Ji, Choi Sang Hyun, Wee Sungwoo, Choi Se Jin, Byun Jae Ho, Won Hyung Jin, Shin Yong Moon, Sirlin Claude B
From the 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, Korea (H.J.J., S.H.C., S.J.C., J.H.B., H.J.W., Y.M.S.); University of Ulsan College of Medicine, Seoul, Korea (S.W.); and Liver Imaging Group, Department of Radiology, University of California- San Diego, San Diego, Calif (C.B.S.).
Radiology. 2024 Dec;313(3):e240961. doi: 10.1148/radiol.240961.
Background Prediction of the tumor growth rates is clinically important in patients with hepatocellular carcinoma (HCC), but previous studies have presented conflicting results and generally lacked radiologic evaluations. Purpose To evaluate the percentage of rapidly growing early-stage HCCs in each Liver Imaging Reporting and Data System (LI-RADS) category and to identify prognostic factors associated with rapid growth. Materials and Methods Retrospective study of patients with risk factors for HCC and those with surgically proven early-stage HCC who underwent two or more preoperative multiphasic CT or MRI examinations between January 2016 and December 2020. LI-RADS categories were assigned according to the baseline CT or MRI results. The tumor volume doubling time (TVDT) was calculated from the tumor volumes measured at the two examinations. The growth rate was classified as rapid (TVDT < 3 months), intermediate (TVDT = 3-9 months), or indolent (TVDT > 9 months). The percentage of rapidly growing HCCs was compared among the LI-RADS categories, and multivariable logistic regression was used to identify factors associated with rapidly growing HCC. Results In 322 patients (mean age, 61 years ± 9 [SD]; 249 men) with 345 HCCs (30 LR-3, 64 LR-4, 221 LR-5, and 30 LR-M category), the median TVDT of HCC was 131 days (IQR, 87-233) and 27.0% of HCCs showed rapid growth. The growth rates differed among the LI-RADS categories, with a higher percentage of rapidly growing HCCs observed for LR-M HCCs than for LR-3 (70.0% vs 3.3%, < .001), LR-4 (70.0% vs 12.5%, < .001), or LR-5 (70.0% vs 28.5%, < .001) HCCs. An α-fetoprotein level greater than 400 ng/mL (adjusted odds ratio [OR], 2.54; 95% CI: 1.16, 5.54; = .02), baseline tumor diameter (adjusted OR, 0.65; 95% CI: 0.48, 0.87; = .004), and LR-M category (adjusted OR, 9.26; 95% CI: 3.70, 23.16; < .001) were independently associated with higher odds of rapid growth. Conclusion Among early-stage HCCs, LR-M category was an independent factor for rapid growth, observed in 70% of HCCs. © RSNA, 2024
预测肿瘤生长速度对肝细胞癌（HCC）患者具有重要的临床意义，但以往研究结果相互矛盾，且普遍缺乏影像学评估。目的：评估各肝脏影像报告和数据系统（LI-RADS）分类中快速生长的早期HCC的比例，并确定与快速生长相关的预后因素。材料与方法：对2016年1月至2020年12月期间有HCC危险因素且经手术证实为早期HCC并接受了两次或更多次术前多期CT或MRI检查的患者进行回顾性研究。根据基线CT或MRI结果指定LI-RADS分类。从两次检查时测量的肿瘤体积计算肿瘤体积倍增时间（TVDT）。生长速度分为快速（TVDT＜3个月）、中等（TVDT = 3 - 9个月）或缓慢（TVDT＞9个月）。比较LI-RADS分类中快速生长的HCC的比例，并使用多变量逻辑回归确定与快速生长的HCC相关的因素。结果：322例患者（平均年龄61岁±9[标准差]；249例男性）有345个HCC（30个LR-3、64个LR-4、221个LR-5和30个LR-M分类），HCC的中位TVDT为131天（四分位间距，87 - 233），27.0%的HCC显示快速生长。LI-RADS分类中的生长速度不同，LR-M HCC中快速生长的HCC比例高于LR-3（70.0%对3.3%，P＜.001）、LR-4（70.0%对12.5%，P＜.001）或LR-5（70.0%对28.5%，P＜.001）HCC。甲胎蛋白水平大于400 ng/mL（调整后的优势比[OR]，2.54；95%可信区间：1.16，5.54；P = .02）、基线肿瘤直径（调整后的OR，0.65；95%可信区间：0.48，0.87；P = .004）和LR-M分类（调整后的OR，9.26；95%可信区间：3.70，23.16；P＜.001）与快速生长的较高几率独立相关。结论：在早期HCC中，LR-M分类是快速生长的独立因素，在70%的HCC中观察到。©RSNA，2024
