Rou Woo Sun, Jeon Hong Jae, Eun Hyuk Soo, Lee Hyun Seok, Park Jae Ho, Joo Jong Seok, Kim Ju Seok, Lee Eaum Seok, Kim Seok Hyun, Lee Jeong Eun, Shin Kyung Sook, Kim Seok-Hwan, Yeo Min-Kyung, Lee Ju-Mi, Kwon In Sun, Lee Byung Seok
Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea.
Gut Liver. 2025 Jul 15;19(4):602-616. doi: 10.5009/gnl240393. Epub 2025 Apr 1.
BACKGROUND/AIMS: No studies have investigated the effects of radiologic-pathologic discordance on the outcomes of patients who have undergone resection for hepatocellular carcinoma (HCC). Therefore, we investigated the effects of these discrepancies on the outcomes of such patients.
This study included patients diagnosed with HCC on magnetic resonance imaging who underwent resection, including 1,790 from the Korean Primary Liver Cancer Registry (nationwide cohort) and 185 from Chungnam National University Hospital (hospital cohorts). Radiologic-pathologic discrepancies in five factors (maximum tumor diameter, tumor number, vascular invasion, bile duct invasion, and lymph node metastasis) were evaluated using Kaplan-Meier and Cox regression analyses.
The survival rate in the nationwide cohort was lower when all five factors were discordant than when all were concordant (p<0.001). A similar trend was observed in the hospital cohort; however, it was not statistically significant (p=0.260). In multivariate analyses, radiologicpathologic discrepancies in more than two factors (hazard ratio [HR], 3.251) and vascular invasion (HRs, 2.044 and 2.596), and lymph node metastasis (HRs, 8.157 and 7.209) on pathology or both imaging and pathology, respectively, were independent predictors of survival (all p<0.001). Similarly, lymph node metastasis on imaging emerged as an independent predictor (HR, 3.386; p=0.009). Age, an alpha-fetoprotein ≥200 ng/mL, and a modified Union for International Cancer Control stage were additional independent predictors.
This is the first study to demonstrate that radiologic-pathologic discordance in patients with HCC who have undergone resection are significantly associated with worse survival. More accurate and appropriate preoperative evaluations are essential for optimizing treatment and improving prognosis.
背景/目的：尚无研究调查放射学-病理学不一致对接受肝细胞癌（HCC）切除术患者预后的影响。因此，我们研究了这些差异对此类患者预后的影响。
本研究纳入了经磁共振成像诊断为HCC并接受切除术的患者，其中包括来自韩国原发性肝癌登记处的1790例（全国队列）和忠南国立大学医院的185例（医院队列）。使用Kaplan-Meier和Cox回归分析评估五个因素（最大肿瘤直径、肿瘤数量、血管侵犯、胆管侵犯和淋巴结转移）的放射学-病理学差异。
在全国队列中，所有五个因素均不一致时的生存率低于所有因素均一致时（p<0.001）。在医院队列中也观察到类似趋势；然而，差异无统计学意义（p=0.260）。在多因素分析中，两个以上因素的放射学-病理学差异（风险比[HR]，3.251）以及病理学上的血管侵犯（HR分别为2.044和2.596）和淋巴结转移（HR分别为8.157和7.209），或影像学和病理学两者上的差异，均是生存的独立预测因素（所有p<0.001）。同样，影像学上的淋巴结转移也是独立预测因素（HR，3.386；p=0.009）。年龄、甲胎蛋白≥200 ng/mL以及国际癌症控制联盟改良分期是其他独立预测因素。
这是第一项证明接受切除术的HCC患者的放射学-病理学不一致与较差生存率显著相关的研究。更准确和适当的术前评估对于优化治疗和改善预后至关重要。
