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Combined hepatocellular carcinoma-cholangiocarcinoma: MRI features correlated with tumor biomarkers and prognosis

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To determine how MRI features are correlated to biomarkers, and to the prognostic factors for recurrence-free survival (RFS) and overall survival (OS) in combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) patients.

Methods

The study enrolled 160 cHCC-CCA patients pathologically confirmed according to the 2019 WHO classification. The preoperative MRI features and clinical data were retrospectively evaluated and compared between patients grouped by AFP or CA19-9 level and with pathological findings. The RFS and OS of cHCC-CCA patients were estimated using Kaplan-Meier survival curves and compared using the log-rank test. Moreover, predictors of RFS and OS were investigated using Cox regression analyses.

Results

One hundred and sixty patients (mean age, males vs. females: 55.7 ± 10.2 years vs. 54.9 ± 14.0 years) were evaluated. The incidence of nodule-in-nodule architecture, mosaic architecture, intratumoral hemorrhage, hepatic capsule retraction, arterial phase peritumoral enhancement, and portal vein thrombus was significantly higher in patients with AFP > 20 ng/ml (all p < 0.05). Multivariate Cox regression analysis indicated that age (HR 1.031, p = 0.03), CA19-9 > 37 U/ml (HR 1.880, p = 0.04), arterial phase peritumoral enhancement (HR 2.287, p = 0.01), and delayed enhancement (HR 0.377, p = 0.02) were independent predictors of poor RFS, while arterial phase peripheral enhancement (HR 2.391, p = 0.04) was an independent predictor of poor OS.

Conclusions

cHCC-CCA imaging features are complex and not correlated with AFP or CA19-9. Age, CA19-9 > 37 U/ml, arterial phase peritumoral enhancement, and delayed enhancement are independent predictors of poor RFS. Arterial phase peripheral enhancement is an independent predictor of poor OS.

Key Points

• The imaging features of combined hepatocellular carcinoma-cholangiocarcinoma are complex and are not correlated with the alpha fetoprotein or CA19-9 levels.

• Age, CA19-9 > 37 U/ml, arterial phase peritumoral enhancement, and delayed enhancement are independent predictors of poor recurrence-free survival in combined hepatocellular carcinoma-cholangiocarcinoma patients.

• Arterial phase peripheral enhancement is an independent predictor of poor overall survival in patients with combined hepatocellular carcinoma-cholangiocarcinoma.

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Abbreviations

AFP:

Alpha fetoprotein

CA19-9:

Carbohydrate antigen 19-9

cHCC-CCA:

Combined hepatocellular carcinoma-cholangiocarcinoma

MVI:

Microvascular invasion

OS:

Overall survival

RFS:

Recurrence-free survival

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Funding

This study has received funding by National Natural Science Foundation of China (grant number 91859107), Shanghai Science and Technology Committee (grant number 18DZ1930102),Shanghai Science and Technology Committee (grant number 19411965500), Zhongshan Hospital, Fudan University (grant number 2018ZSLC22), Shanghai Municipal Key Clinical Specialty (grant number W2019-018), Clinical Research Plan of SHDC (grant number SHDC2020CR1029B), and Zhongshan Hospital, Fudan University (grant number 2020ZSLC61).

Author information

Author notes

  1. Changwu Zhou and Yi Wang contributed equally to this work.

Authors and Affiliations

  1. Shanghai Institute of Medical Imaging, Shanghai, China

    Changwu Zhou, Li Ma & Mengsu Zeng

  2. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Changwu Zhou, Yi Wang, Xianling Qian, Chun Yang & Mengsu Zeng

Authors
  1. Changwu Zhou
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  2. Yi Wang
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Corresponding authors

Correspondence to Chun Yang or Mengsu Zeng.

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Guarantor

The scientific guarantor of this publication is Mengsu Zeng.

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:

Two of the authors (Changwu Zhou and Li Ma) have significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in a prior study entitled “Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance?” on a publication of European Radiology.

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• retrospective

• observational

• performed at one institution

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Zhou, C., Wang, Y., Ma, L. et al. Combined hepatocellular carcinoma-cholangiocarcinoma: MRI features correlated with tumor biomarkers and prognosis. Eur Radiol 32, 78–88 (2022). https://doi.org/10.1007/s00330-021-08188-y

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  • DOI: https://doi.org/10.1007/s00330-021-08188-y

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