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Liao ZJ, Lu L, Liu YP, Qin GG, Fan CG, Liu YP, Jia NY, Zhang L. Clinical and DCE-CT signs in predicting microvascular invasion in cHCC-ICC. Cancer Imaging 2023; 23:112. [PMID: 37978567 PMCID: PMC10655417 DOI: 10.1186/s40644-023-00621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND To predict the microvascular invasion (MVI) in patients with cHCC-ICC. METHODS A retrospective analysis was conducted on 119 patients who underwent CT enhancement scanning (from September 2006 to August 2022). They were divided into MVI-positive and MVI-negative groups. RESULTS The proportion of patients with CEA elevation was higher in the MVI-positive group than in the MVI-negative group, with a statistically significant difference (P = 0.02). The MVI-positive group had a higher rate of peritumoral enhancement in the arterial phase (P = 0.01) whereas the MVI-negative group had more oval and lobulated masses (P = 0.04). According to the multivariate analysis, the increase in CEA (OR = 10.15, 95% CI: 1.11, 92.48, p = 0.04), hepatic capsular withdrawal (OR = 4.55, 95% CI: 1.44, 14.34, p = 0.01) and peritumoral enhancement (OR = 6.34, 95% CI: 2.18, 18.40, p < 0.01) are independent risk factors for predicting MVI. When these three imaging signs are combined, the specificity of MVI prediction was 70.59% (series connection), and the sensitivity was 100% (parallel connection). CONCLUSIONS Our multivariate analysis found that CEA elevation, liver capsule depression, and arterial phase peritumoral enhancement were independent risk factors for predicting MVI in cHCC-ICC.
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Affiliation(s)
- Zhong-Jian Liao
- Medical Imaging Department of Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Lun Lu
- Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China
| | - Yi-Ping Liu
- Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China
| | - Geng-Geng Qin
- Medical Imaging Department of Ganzhou People's Hospital, Ganzhou, 341000, China
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Cun-Geng Fan
- Medical Imaging Department of Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Yan-Ping Liu
- Medical Imaging Department of Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Ning-Yang Jia
- Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China.
| | - Ling Zhang
- Medical Imaging Department of Ganzhou People's Hospital, Ganzhou, 341000, China.
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Ji GW, Xu Q, Jiao CY, Lu M, Xu ZG, Zhang B, Yang Y, Wang K, Li XC, Wang XH. Translating imaging traits of mass-forming intrahepatic cholangiocarcinoma into the clinic: From prognostic to therapeutic insights. JHEP Rep 2023; 5:100839. [PMID: 37663120 PMCID: PMC10468367 DOI: 10.1016/j.jhepr.2023.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/23/2023] [Accepted: 06/16/2023] [Indexed: 09/05/2023] Open
Abstract
Background & Aims The progress toward clinical translation of imaging biomarkers for mass-forming intrahepatic cholangiocarcinoma (MICC) is slower than anticipated. Questions remain on the biologic behaviour underlying imaging traits. We developed and validated imaging-based prognostic systems for resected MICCs with an appraisal of the tumour immune microenvironment (TIME) underpinning patient-specific imaging traits. Methods Between January 2009 and December 2019, a total of 322 patients who underwent dynamic computed tomography/magnetic resonance imaging and curative-intent resection for MICC at three hepatobiliary institutions were retrospectively recruited, divided into training (n = 193) and validation (n = 129) datasets. Two radiological and clinical scoring (RACS) systems, one integrating preoperative variables and one integrating preoperative and postoperative variables, were developed using Cox regression analysis. We then prospectively analysed the TIME of tissue samples from 20 patients who met study criteria from January 2021 to December 2021 using multiplexed immunofluorescence. Results Preoperative and postoperative MICC-RACS systems built on carbohydrate antigen 19-9, albumin, tumour number, radiological/pathological nodal status, pathological necrosis, and three radiological traits (arterial enhancement pattern, tumour boundary, and capsular retraction) demonstrated good performance in predicting disease-specific (C-statistic >0.80) and disease-free (C-statistic >0.75) survival that outperformed rival models and staging systems across study cohorts (P <0.05 for all). Patients with MICC-RACS score of 0-2 (low risk), 3-5 (medium risk), and ≥6 (high risk) had incrementally worse prognosis after surgery. Significant differences in spatial distribution and infiltration level of immune cells were identified between arterial enhancement patterns. Enhanced infiltration of immunosuppressive regulatory T cells and M2-like macrophages at the invasive margin were noted in tumours with distinct boundary and capsular retraction, respectively. Conclusions Our MICC-RACS systems are simple but powerful prognostic tools that may facilitate the understanding of spatially distinct TIMEs and patient-tailored immunotherapy approach. Impact and Implications The progress toward clinical translation of imaging biomarkers for mass-forming intrahepatic cholangiocarcinoma (MICC) is slower than anticipated. Questions remain on the biologic behaviour of MICC underlying imaging traits. In this study, we proposed novel and easy-to-use tools, built on radiological and clinical features, that demonstrated good performance in predicting the prognosis either before or after surgery and outperformed rival models/systems across major imaging modalities. The characteristic radiological traits integrated into prognostic systems (arterial enhancement pattern, tumour boundary, and capsular retraction) were highly correlated with heterogeneous tumour-immune microenvironments, thereby renovating treatment paradigms for this difficult-to-treat disease.
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Affiliation(s)
- Gu-Wei Ji
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, PR China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, PR China
| | - Qing Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Chen-Yu Jiao
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, PR China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, PR China
| | - Ming Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Zheng-Gang Xu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, PR China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, PR China
| | - Biao Zhang
- Department of General Surgery, Yancheng No.1 People’s Hospital, Yancheng, PR China
| | - Yue Yang
- Department of General Surgery, The First People’s Hospital of Changzhou, Changzhou, PR China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, PR China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, PR China
| | - Xiang-Cheng Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, PR China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, PR China
| | - Xue-Hao Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, PR China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, PR China
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Feng L, Li M, Huang Z, Xu M. Hepatic epithelioid hemangioendothelioma-a single-institution experience with 51 cases. Front Oncol 2023; 13:1236134. [PMID: 37601682 PMCID: PMC10435877 DOI: 10.3389/fonc.2023.1236134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives The aim of the present study was to describe the experience at a single institution in the management of hepatic epithelioid hemangioendothelioma (HEHE). Methods We included 51 patients with histologically confirmed HEHE. We performed log-rank (Cox-Mantel) survival analyses using Kaplan-Meier methods to test differences in survival between patients in different groups. Univariate Cox regression analyses and multivariate proportional hazards regression model were carried out to identify independent prognostic factors. Results Different imaging modalities were used to diagnose HEHE with various presentations. Liver resection (LR), liver transplantation (LT), systemic treatment (ST), and surveillance had been used in our study. A significant difference was noted between the LR group and the surveillance group with respect to mean survival (p = 0.006), as was in the LR group and the ST group (p = 0.036), and in surgical approach (LR and LT) and nonsurgical approach (ST and surveillance) (p = 0.008). The mean survival between the ST group and the surveillance group was not significantly different (p = 0.851). LR (p = 0.010) and surgical approach (p = 0.014) were favorable predictors of outcome, while macrovascular invasion (MaVI) (p = 0.037), lung metastasis (p = 0.040), and surveillance (p = 0.033) were poor prognostic factors in univariate analysis. Multivariate analysis showed that LR (p = 0.010) and surgical approach (p = 0.014) were independently associated with good OS, while surveillance (p = 0.033) was independently associated with poor OS. After adjusting for confounding factors, patients in the LR group have much better OS than those in the surveillance group (p = 0.013). However, there was no significant difference in OS between the LR group and ST group (p = 0.254), as was in the ST group and the surveillance group (p = 0.857). Conclusions The definitive diagnosis of HEHE was dependent on histopathology, and it was not possible to make a specific diagnosis without biopsy because the radiological findings were similar to those in some hepatic malignancies. ST was not recommended for patients who were not candidates for surgical approaches, and surgical approaches should be warranted regardless of disease stage. The retrospective nature and the small size of the data limited the generalizability of the study, designing a worldwide database that contains all data about patients with HEHE independent of their therapy, which was highly recommended.
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Affiliation(s)
- Lei Feng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Manjie Li
- Radiology Department of West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhuo Huang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingqing Xu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Jiao CY, Zhang H, Ji GW, Xu Q, Lu M, Zhang B, Yang Y, Wang XH, Li XC. CT-based clinico-radiological nomograms for prognosis prediction in patients with intrahepatic mass-forming cholangiocarcinoma: a multi-institutional study. Eur Radiol 2022; 32:8326-8338. [PMID: 35708837 DOI: 10.1007/s00330-022-08914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/06/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To establish prognostic nomograms based on CT imaging features for predicting the prognosis in patients with intrahepatic mass-forming cholangiocarcinoma (IMCC) before and after surgery. METHODS Two models were established for overall survival (OS) prediction in a training set (179 IMCC patients underwent surgery at institution 1 from 2009 to 2019): imaging-based nomogram included imaging features and clinical characteristics acquired before surgery; postoperative nomogram included imaging-based score, equal to the linear predictor of the imaging-based nomogram, and pathological parameters. Both prognostic nomograms were validated in an independent external dataset (103 IMCC patients received surgical treatment at two independent institutions from 2009 to 2019). Predictive performance and discrimination were evaluated and compared with the common prognostic models. RESULTS The imaging-based nomogram was developed according to preoperative serum carbohydrate antigen 19-9 and four imaging features including multiple nodules, arterial enhancement pattern, CT-reported lymph node (LN) metastasis, and capsular retraction; the postoperative nomogram was built based on the imaging-based score and three pathological parameters including tumor differentiation grade, capsular invasion, and LN status. Both nomograms presented improved prognostic performance and discrimination (concordance index, 0.770-0.812; integrated Brier score, 0.120-0.138) compared with the common prognostic models in the training and external validation datasets. Besides, the nomograms stratified IMCC patients into two risk strata for OS. CONCLUSIONS Nomograms based on CT imaging features can provide accurate individual survival prediction for IMCC patients before and after surgery, which may help to improve personalized treatment. KEY POINTS • Imaging features including multiple nodules, arterial enhancement pattern, CT-reported LN metastasis, and capsular retraction were poor independent prognostic factors for IMCC patients. • The imaging-based nomograms presented improved prognostic performance and discrimination compared with the common prognostic models. • The nomograms can provide accurate individual survival prediction for IMCC patients before and after surgery.
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Affiliation(s)
- Chen Yu Jiao
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China.,Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, Jiangsu Province, People's Republic of China
| | - Hui Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China.,Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, Jiangsu Province, People's Republic of China
| | - Gu Wei Ji
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China. .,Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, Jiangsu Province, People's Republic of China.
| | - Qing Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China.
| | - Ming Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Biao Zhang
- Department of General Surgery, Yancheng First Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Yue Yang
- Department of General Surgery, Changzhou First Hospital, Changzhou, Jiangsu Province, People's Republic of China
| | - Xue Hao Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China.,Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, Jiangsu Province, People's Republic of China
| | - Xiang Cheng Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China. .,Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, Jiangsu Province, People's Republic of China.
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Mathew RP, Sam M, Raubenheimer M, Patel V, Low G. Hepatic hemangiomas: the various imaging avatars and its mimickers. Radiol Med 2020; 125:801-815. [DOI: 10.1007/s11547-020-01185-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
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Mamone G, Di Piazza A, Carollo V, Cannataci C, Cortis K, Bartolotta TV, Miraglia R. Imaging of hepatic hemangioma: from A to Z. Abdom Radiol (NY) 2020; 45:672-691. [PMID: 31686179 DOI: 10.1007/s00261-019-02294-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.
| | - Ambra Di Piazza
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Vincenzo Carollo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | | | - Kelvin Cortis
- Department of Radiology, Mater Dei Hospital, Msida, Malta
| | - Tommaso Vincenzo Bartolotta
- Dipartimento di Biomedicina, neuroscienze e diagnostica avanzata (Bi.ND) - Università degli studi di Palermo, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
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