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Risk stratification of solitary hepatocellular carcinoma ≤ 5 cm without microvascular invasion: prognostic values of MR imaging features based on LI-RADS and clinical parameters

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To estimate the potential of preoperative MR imaging features and clinical parameters in the risk stratification of patients with solitary hepatocellular carcinoma (HCC) ≤ 5 cm without microvascular invasion (MVI) after hepatectomy.

Methods

The study enrolled 166 patients with histopathological confirmed MVI-negative HCC retrospectively. The MR imaging features were evaluated by two radiologists independently. The risk factors associated with recurrence-free survival (RFS) were identified by univariate Cox regression analysis and the least absolute shrinkage and selection operator Cox regression analysis. A predictive nomogram was developed based on these risk factors, and the performance was tested in the validation cohort. The RFS was analyzed by using the Kaplan–Meier survival curves and log-rank test.

Results

Among the 166 patients with solitary MVI-negative HCC, 86 patients presented with postoperative recurrence. Multivariate Cox regression analysis indicated that cirrhosis, tumor size, hepatitis, albumin, arterial phase hyperenhancement (APHE), washout, and mosaic architecture were risk factors associated with poor RFS and then incorporated into the nomogram. The nomogram achieved good performance with C-index values of 0.713 and 0.707 in the development and validation cohorts, respectively. Furthermore, patients were stratified into high- and low-risk subgroups, and significant prognostic differences were found between the different subgroups in both cohorts (p < 0.001 and p = 0.024, respectively).

Conclusion

The nomogram incorporated preoperative MR imaging features, and clinical parameters can be a simple and reliable tool for predicting RFS and achieving risk stratification in patients with solitary MVI-negative HCC.

Key Points

• Application of preoperative MR imaging features and clinical parameters can effectively predict RFS in patients with solitary MVI-negative HCC.

• Risk factors including cirrhosis, tumor size, hepatitis, albumin, APHE, washout, and mosaic architecture were associated with worse prognosis in patients with solitary MVI-negative HCC.

• Based on the nomogram incorporating these risk factors, the MVI-negative HCC patients could be stratified into two subgroups with significant different prognoses.

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Abbreviations

ALBI:

Albumin-bilirubin

APHE:

Arterial phase hyperenhancement

BCLC:

Barcelona Clinic Liver Cancer

CI:

Confidence intervals

HR:

Hazard ratios

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

MVI:

Microvascular invasion

RFS:

Recurrence-free survival

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Funding

This study is supported by the National Key Research and Development Program of China (No. 2020AAA0109503).

Author information

Author notes

  1. Leyao Wang and Bing Feng contributed equally to this work.

  2. **aohong Ma and **nming Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei**g, 100021, China

    Leyao Wang, Bing Feng, Dengfeng Li, Meng Liang, Shuang Wang, **aohong Ma & **nming Zhao

  2. Magnetic Resonance Imaging Research, General Electric Healthcare (China), Bei**g, 100176, China

    Sicong Wang

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  1. Leyao Wang
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Correspondence to **aohong Ma or **nming Zhao.

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The scientific guarantor of this publication is **nming Zhao.

Conflict of interest

One of the authors (Sicong Wang) is an employee of General Electric Healthcare China. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Sicong Wang kindly provided statistical advice for this manuscript.

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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Wang, L., Feng, B., Li, D. et al. Risk stratification of solitary hepatocellular carcinoma ≤ 5 cm without microvascular invasion: prognostic values of MR imaging features based on LI-RADS and clinical parameters. Eur Radiol 33, 3592–3603 (2023). https://doi.org/10.1007/s00330-023-09484-5

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