Zheng Tianying, Sheng Liuji, Wu Yuanan, Zhu Xiaomei, Yang Yang, Zhang Xiaoyun, Bashir Mustafa R, Ronot Maxime, Sun Hui-Chuan, Wang Yanshu, Song Bin, Jiang Hanyu
Department of Radiology, West China Hospital Sichuan University Chengdu Sichuan China.
Cancer Center, West China Hospital Sichuan University Chengdu Sichuan China.
Eur J Radiol. 2025 Mar;184:111945. doi: 10.1016/j.ejrad.2025.111945. Epub 2025 Jan 22.
To develop and validate an MRI-based model for predicting postoperative early (≤2 years) recurrence-free survival (RFS) in patients receiving upfront surgical resection (SR) for beyond Milan hepatocellular carcinoma (HCC) and to assess the model's performance in separate patients receiving neoadjuvant therapy for similar-stage tumors.
This single-center retrospective study included consecutive patients with resectable BCLC A/B beyond Milan HCC undergoing upfront SR or neoadjuvant therapy. All images were independently evaluated by three blinded radiologists. In patients receiving upfront SR, an MRI-based Early Recurrence Outside Milan (EROM) score was developed and validated for predicting early RFS via Cox regression analyses and compared with the BCLC staging system. In separate patients undergoing neoadjuvant therapy, interval tumor progression rate and postoperative early RFS were compared between EROM-predicted high- and low-risk groups.
279 patients (median, 56 years; 236 men) were included, 220 (78.9 %) undergoing upfront SR and 59 (21.1 %) received transarterial chemoembolization-based neoadjuvant therapy. Alpha-fetoprotein > 20 ng/mL (HR, 2.03; P = 0.007), size of the largest tumor (HR, 1.10; P = 0.016), infiltrative appearance (HR, 2.20; P = 0.032), and < 50 % arterial phase hyperenhancement (HR, 1.74; P = 0.023) formed the EROM score, with superior testing dataset C-index than the BCLC system (0.69 vs. 0.52, P < 0.001). The EROM-predicted high-risk (>15.3 points) patients had higher tumor progression (25.0 % vs. 0.0 %, P = 0.033) and lower postoperative 2-year RFS (16.0 % vs. 39.3 %, P = 0.025) rates after neoadjuvant therapy.
In patients with resectable beyond Milan HCC, EROM allowed noninvasive prediction of postoperative early RFS and informed interval tumor progression risks after neoadjuvant therapy.
建立并验证一种基于磁共振成像（MRI）的模型，用于预测接受 upfront 手术切除（SR）的米兰以外肝细胞癌（HCC）患者术后早期（≤2 年）无复发生存期（RFS），并评估该模型在接受新辅助治疗的类似分期肿瘤患者中的性能。
这项单中心回顾性研究纳入了连续的可切除 BCLC A/B 期米兰以外 HCC 患者，这些患者接受 upfront SR 或新辅助治疗。所有图像均由三名盲法放射科医生独立评估。在接受 upfront SR 的患者中，通过 Cox 回归分析建立并验证了基于 MRI 的米兰外早期复发（EROM）评分，用于预测早期 RFS，并与 BCLC 分期系统进行比较。在接受新辅助治疗的独立患者中，比较 EROM 预测的高风险组和低风险组之间的间期肿瘤进展率和术后早期 RFS。
纳入 279 例患者（中位年龄 56 岁；236 例男性），220 例（78.9%）接受 upfront SR，59 例（21.1%）接受基于经动脉化疗栓塞的新辅助治疗。甲胎蛋白>20 ng/mL（HR，2.03；P = 0.007）、最大肿瘤大小（HR，1.10；P = 0.016）、浸润性表现（HR，2.20；P = 0.032）和动脉期强化<50%（HR，1.74；P = 0.023）构成 EROM 评分，其测试数据集 C 指数优于 BCLC 系统（0.69 对 0.52，P < 0.001）。EROM 预测的高风险（>15.3 分）患者在新辅助治疗后具有更高的肿瘤进展率（25.0%对 0.0%，P = 0.033）和更低的术后 2 年 RFS（16.0%对 39.3%，P = 0.025）。
在可切除的米兰以外 HCC 患者中，EROM 可实现对术后早期 RFS 的无创预测，并提示新辅助治疗后的间期肿瘤进展风险。
