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Prognostic significance of MRI features in patients with solitary large hepatocellular carcinoma following surgical resection

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

Abstract

Objective

To assess the prognostic impact of preoperative MRI features on outcomes for single large hepatocellular carcinoma (HCC) (≥ 8 cm) after surgical resection.

Material and methods

This retrospective study included 151 patients (mean age: 59.2 years; 126 men) with a single large HCC who underwent gadoxetic acid-enhanced MRI and surgical resection between 2008 and 2020. Clinical variables, including tumor markers and MRI features (tumor size, tumor margin, and the proportion of hypovascular component on hepatic arterial phase (AP) (≥ 50% vs. < 50% tumor volume) were evaluated. Cox proportional hazards model analyzed overall survival (OS), recurrence-free survival (RFS), and associated factors.

Results

Among 151 HCCs, 37.8% and 62.2% HCCs were classified as ≥ 50% and < 50% AP hypovascular groups, respectively. The 5- and 10-year OS and RFS rates in all patients were 62.0%, 52.6% and 41.4%, 38.5%, respectively. Multivariable analysis revealed that ≥ 50% AP hypovascular group (hazard ratio [HR] 1.7, p = 0.048), tumor size (HR 1.1, p = 0.006), and alpha-fetoprotein ≥ 400 ng/mL (HR 2.6, p = 0.001) correlated with poorer OS. ≥ 50% AP hypovascular group (HR 1.9, p = 0.003), tumor size (HR 1.1, p = 0.023), and non-smooth tumor margin (HR 2.1, p = 0.009) were linked to poorer RFS. One-year RFS rates were lower in the ≥ 50% AP hypovascular group than in the < 50% AP hypovascular group (47.4% vs 66.9%, p = 0.019).

Conclusion

MRI with ≥ 50% AP hypovascular component and larger tumor size were significant factors associated with poorer OS and RFS after resection of single large HCC (≥ 8 cm). These patients require careful multidisciplinary management to determine optimal treatment strategies.

Clinical relevance statement

Preoperative MRI showing a ≥ 50% arterial phase hypovascular component and larger tumor size can predict worse outcomes after resection of single large hepatocellular carcinomas (≥ 8 cm), underscoring the need for tailored, multidisciplinary treatment strategies.

Key Points

  • MRI features offer insights into the postoperative prognosis for large hepatocellular carcinoma.

  • Hypovascular component on arterial phase ≥ 50% and tumor size predicted poorer overall survival and recurrence-free survival.

  • These findings can assist in prioritizing aggressive and multidisciplinary approaches for patients at risk for poor outcomes.

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Abbreviations

AFP:

Alpha-fetoprotein

ALBI:

Albumin-bilirubin

APHE:

Arterial phase hyperenhancement

BCLC:

Barcelona clinic liver cancer

CI:

Confidence interval

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

MTM:

Macrotrabecular-massive

NHHN:

Nonhypervascular hypointense nodule

OS:

Overall survival

PIVKA-II:

Protein induced by vitamin K absence-II

RFS:

Recurrence-free survival

TARE:

Transarterial radioembolization

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Kyowon Gu, Ji Hye Min, Jeong Hyun Lee, Jaeseung Shin, Woo Kyoung Jeong, Young Kon Kim, Honsoul Kim & Sun-Young Baek

  2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jong Man Kim, Gyu Seong Choi & **soo Rhu

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sang Yun Ha

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  1. Kyowon Gu
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Correspondence to Ji Hye Min.

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Guarantor

The scientific guarantor of this publication is Ji Hye Min in Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Sun-Young Baek, one of the authors, has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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The Institutional Review Board of the Samsung Medical Center (IRB number: 2023-04-085) approved this study.

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Gu, K., Min, J.H., Lee, J.H. et al. Prognostic significance of MRI features in patients with solitary large hepatocellular carcinoma following surgical resection. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10780-x

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