Song Wenlong, Xu Yang, Zhou Jun, Yu Jiayi, He Xiaojing, Jiang Caiming, Guo Dajing
Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Radiology, The Beibei Affiliated Hospital of Chongqing Medical University, The Ninth People's Hospital of Chongqing, Chongqing, China.
Eur Radiol. 2025 Apr 11. doi: 10.1007/s00330-025-11558-5.
To develop models including MRI features for predicting recurrence-free survival (RFS) in patients with solitary small hepatocellular carcinoma (SHCC) following curative resection according to alpha-fetoprotein (AFP) expression and for achieving risk stratification.
A total of 201 solitary SHCC patients diagnosed pathologically who underwent MRI were enrolled retrospectively and divided into AFP-negative (n = 85) and AFP-positive (n = 116) SHCC groups. Clinicopathological factors, imaging features, and geometric parameters associated with RFS were determined by univariate and multivariate Cox analyses. Two prognostic models predicting postresection RFS were developed by multivariate Cox proportional hazard model, and their discriminatory ability was evaluated by the concordance index (C-index) and conducted internal validation. Kaplan‒Meier analysis with RFS as the endpoint was used to assess model performance.
The predictors of RFS in AFP-negative SHCC included mosaic architecture, portal-venous phase tumor-to-right erector spinae muscle signal intensity ratio, and sphericity, whereas those in AFP-positive SHCC were liver cirrhosis, tumor growth subtype, and asphericity. The C-indexes of the models in predicting RFS in AFP-negative and AFP-positive SHCC were 0.700 and 0.717, respectively. The risk probability calculated with the models stratified the two patient subgroups into two risk groups with significantly different survival outcomes (p < 0.001).
Our two prognostic models may assist physicians in stratifying risk and monitoring relapses in patients with AFP-negative or AFP-positive solitary SHCCs.
Question This study explored the predictors of the postresection outcomes of patients with small hepatocellular carcinoma according to the level of alpha-fetoprotein expression. Findings Pretreatment MRI and geometric features can serve as prognostic markers for predicting postoperative recurrence-free survival of small hepatocellular carcinoma with different alpha-fetoprotein expression. Clinical relevance Our models guide clinicians in administering appropriate therapeutic decisions and implementing proper postoperative monitoring regimens in different alpha-fetoprotein expression small hepatocellular carcinoma patients.
建立包含MRI特征的模型，用于根据甲胎蛋白（AFP）表达预测根治性切除术后孤立性小肝细胞癌（SHCC）患者的无复发生存期（RFS），并实现风险分层。
回顾性纳入201例经病理诊断并接受MRI检查的孤立性SHCC患者，分为AFP阴性（n = 85）和AFP阳性（n = 116）SHCC组。通过单因素和多因素Cox分析确定与RFS相关的临床病理因素、影像特征和几何参数。采用多因素Cox比例风险模型建立两个预测切除术后RFS的预后模型，并通过一致性指数（C指数）评估其判别能力，进行内部验证。以RFS为终点的Kaplan-Meier分析用于评估模型性能。
AFP阴性SHCC中RFS的预测因素包括镶嵌结构、门静脉期肿瘤与右侧竖脊肌信号强度比以及球形度，而AFP阳性SHCC中的预测因素为肝硬化、肿瘤生长亚型和非球形度。预测AFP阴性和AFP阳性SHCC患者RFS的模型C指数分别为0.700和0.717。用模型计算的风险概率将两个患者亚组分为两个生存结果显著不同的风险组（p < 0.001）。
我们的两个预后模型可能有助于医生对AFP阴性或AFP阳性孤立性SHCC患者进行风险分层和复发监测。
问题 本研究根据甲胎蛋白表达水平探讨了小肝细胞癌患者切除术后结局的预测因素。发现 术前MRI和几何特征可作为预测不同甲胎蛋白表达的小肝细胞癌术后无复发生存期的预后标志物。临床意义 我们的模型指导临床医生对不同甲胎蛋白表达的小肝细胞癌患者做出适当的治疗决策并实施适当的术后监测方案。
