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Prognostic factors of gadoxetic acid–enhanced MRI for postsurgical outcomes in multicentric hepatocellular carcinoma

  • Hepatobiliary-Pancreas
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Abstract

Objectives

The primary aim of this study was to determine the clinical and histopathological prognostic factors for patients who underwent surgical resection of multiple hepatocellular carcinomas (HCCs) of multicentric occurrence. The secondary aim of this study was to evaluate whether specific imaging-related factors, including arterial phase hyperenhancement (APHE) and the LI-RADS category of each lesion on gadoxetic acid–enhanced MRI, would provide additional prognostic information about multicentric HCCs.

Methods

In this retrospective study, 54 patients with 120 multicentric HCCs were diagnosed by surgical resection at a single tertiary hospital between 2009 and 2014. Two independent readers evaluated patients’ preoperative gadoxetic acid–enhanced MR images and recorded APHE and LI-RADS category for each HCC, with discrepancies resolved through consensus sessions if necessary. Potential clinicopathologic and imaging parameters for predicting disease-free survival (DFS) and overall survival (OS) were analyzed using Cox regression analysis.

Results

Presence of microvascular invasion (MVI) (p = 0.003) and of three or more HCCs (p = 0.013) were both independent predictors of a shorter DFS. Patients with concurrent MVI and three or more HCCs had the shortest DFS. MVI was the only statistically significant parameter (p = 0.023) predicting OS. The number of HCCs with APHE or LR-5/M category was not associated with survival.

Conclusions

Presence of MVI and of three or more HCCs were associated with poorer outcomes after surgical resection of multicentric HCCs. Imaging parameters on gadoxetic acid–enhanced MRI such as APHE or LI-RADS category were not associated with postsurgical outcomes.

Key Points

• Patients with three or more hepatocellular carcinomas showed worse disease-free survival than those with two hepatocellular carcinomas after surgical resection.

• Microvascular invasion was the only significant factor to affect both the disease-free and overall survivals of patients after surgical resection of multicentric hepatocellular carcinomas.

• Preoperative MRI findings related to multicentric hepatocellular carcinomas such as arterial phase hyperenhancement and LI-RADS category of lesions did not provide significant prognostic information.

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Abbreviations

AFP:

Alpha-fetoprotein

APHE:

Arterial phase hyperenhancement

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MVI:

Microvascular invasion

NHHN:

Non-hypervascular hepatobiliary phase hypointense nodule

PIVKA-II:

Protein induced by vitamin K absence or antagonist-II

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Seung-seob Kim, Sunyoung Lee & Myeong-Jin Kim

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  1. Seung-seob Kim
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  2. Sunyoung Lee
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  3. Myeong-Jin Kim
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Correspondence to Myeong-Jin Kim.

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The scientific guarantor of this publication is Myeong-Jin Kim, MD, PhD.

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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.

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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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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Kim, Ss., Lee, S. & Kim, MJ. Prognostic factors of gadoxetic acid–enhanced MRI for postsurgical outcomes in multicentric hepatocellular carcinoma. Eur Radiol 31, 3405–3416 (2021). https://doi.org/10.1007/s00330-020-07419-y

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  • DOI: https://doi.org/10.1007/s00330-020-07419-y

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