Zhang Juan, Luo Hongmei, Li Yinqiao, Feng Yayuan, Pan Xingpeng, Ouyang Beilei, Nian Guihong, Jia Ningyang, Li Yonggang
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, 215006, People's Republic of China.
Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, Shanghai, 200438, People's Republic of China.
J Hepatocell Carcinoma. 2025 Jul 18;12:1471-1482. doi: 10.2147/JHC.S530701. eCollection 2025.
This study aims to evaluate the prognostic predictive efficacy of Gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) in patients with solitary hepatocellular carcinoma (HCC) without microvascular invasion (MVI) and to investigate the potential clinical and imaging parameters for stratifying the risk of recurrence following hepatectomy.
This retrospective study included 134 patients with histopathologically confirmed solitary HCC without microvascular invasion (MVI) from two hospital districts, which divided into the training cohort and validation cohort. MRI features were independently assessed by two radiologists. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors associated with recurrence-free survival (RFS). A nomogram was developed based on these factors, and its performance was validated in the validation cohort. RFS was analyzed using Kaplan-Meier curves and the Log rank test.
The median RFS for the 134 patients was 45.7 months, with 41.8% of patients experiencing tumor recurrence after hepatectomy. Univariate Cox regression analysis identified hepatitis Be antigen (HBeAg) positivity, tumor size, tumor growth subtype, non-peripheral washout, nodule-in-nodule architecture, mosaic architecture, and intratumoral arteries as significant risk factors for RFS. Multivariate Cox regression analysis revealed that HBeAg positive, tumor growth subtype, non-peripheral washout, mosaic architecture, and internal arteries were independent prognostic factors for RFS in patients with solitary HCC without MVI. The nomogram based on these variables demonstrated good predictive accuracy, with concordance indices (C-index) of 0.740 and 0.701 in the training and validation cohorts, respectively. Additionally, patients in the high-risk group exhibited significantly lower RFS compared to those in the low-risk group.
A model incorporating Gd-BOPTA-enhanced MRI and clinical features can effectively predict RFS in solitary HCC patients without MVI and assist in risk stratification for recurrence after hepatectomy.
本研究旨在评估钆贝葡胺（Gd-BOPTA）增强磁共振成像（MRI）对无微血管侵犯（MVI）的孤立性肝细胞癌（HCC）患者的预后预测效能，并探讨用于肝切除术后复发风险分层的潜在临床和影像参数。
这项回顾性研究纳入了来自两个院区的134例经组织病理学证实为无微血管侵犯（MVI）的孤立性HCC患者，分为训练队列和验证队列。两名放射科医生独立评估MRI特征。进行单因素和多因素Cox回归分析以确定与无复发生存期（RFS）相关的独立危险因素。基于这些因素构建列线图，并在验证队列中验证其性能。使用Kaplan-Meier曲线和Log rank检验分析RFS。
134例患者的中位RFS为45.7个月，41.8%的患者肝切除术后出现肿瘤复发。单因素Cox回归分析确定乙肝e抗原（HBeAg）阳性、肿瘤大小、肿瘤生长亚型、非周边廓清、结节中结节结构、镶嵌结构和瘤内动脉为RFS的显著危险因素。多因素Cox回归分析显示，HBeAg阳性、肿瘤生长亚型、非周边廓清、镶嵌结构和内部动脉是无MVI的孤立性HCC患者RFS的独立预后因素。基于这些变量的列线图显示出良好的预测准确性，训练队列和验证队列中的一致性指数（C指数）分别为0.740和0.701。此外，高危组患者的RFS显著低于低危组患者。
结合Gd-BOPTA增强MRI和临床特征的模型可以有效预测无MVI的孤立性HCC患者的RFS，并有助于肝切除术后复发的风险分层。
