Establishment and Evaluation of a Predictive Model for Early Postoperative Recurrence of Hepatocellular Carcinoma in Patients with Microvascular Invasion

A model incorporating histopathology and preoperative gadoxetic acid-enhanced MRI to predict early recurrence of hepatocellular carcinoma without microvascular invasion after curative hepatectomy

OBJECTIVES

To assess the predictive value of preoperative gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI) features and postoperative histopathological grading for early recurrence of hepatocellular carcinoma (HCC) without microvascular invasion (MVI) after curative hepatectomy.

METHODS

A total of 85 MVI-negative HCC cases were retrospectively analyzed. Cox analyses were used to identify the independent predictors of early recurrence (within a 24 months span). The clinical prediction Model-1 or Model-2 was established without or with postoperative pathological factor, respectively. Nomogram models were constructed and receiver operating characteristic (ROC) curve analysis was used to assess the models' predictive ability. Internal validation of the prediction models for early HCC recurrence was performed using a bootstrap re-sampling approach.

RESULTS

In the multivariate cox regression analysis, Edmondson-Steiner grade, peritumoral hypointensity on hepatobiliary phase (HBP), and relative intensity ratio (RIR) in HBP were identified as independent variables associated with early recurrence. The C-index of the nomogram models and internal validation were both between 0.7 and 0.8, showing good model fitting and calibration effects. The area under the ROC curve (AUC) was 0.781 for Model-1 based on the two preoperative MRI factors. When a third factor, the Edmondson-Steiner grade, was included (Model-2), the AUC increased to 0.834, and the sensitivity increased from 71.4 to 96.4%.

CONCLUSIONS

Edmondson-Steiner grade, peritumoral hypointensity on HBP, and RIR on HBP can help predict early recurrence of MVI-negative HCC. In comparison with Model-1 (only imaging features), Model-2 (imaging features + histopathological grades) increases the sensitivity in predicting early recurrence of HCC without MVI.

ADVANCES IN KNOWLEDGE

Preoperative GA-enhanced MRI signs are of great value in predicting early postoperative recurrence of HCC without MVI, and a combined pathological model was established to evaluate the feasibility and effectiveness of this technique.

Pre-operative MRI features predict early post-operative recurrence of hepatocellular carcinoma with different degrees of pathological differentiation

PURPOSE

To investigate the value of pre-operative gadoxetate disodium (Gd-EOB-DTPA) enhanced MRI predicting early post-operative recurrence (< 2 years) of hepatocellular carcinoma (HCC) with different degrees of pathological differentiation.

METHODS

Retrospective analysis of pre-operative MR imaging features of 177 patients diagnosed as suffering from HCC and that underwent radical resection. Multivariate logistic regression assessment was adopted to assess predictors for HCC recurrence with different degrees of pathological differentiation. The area under the curve (AUC) of receiver operating characteristics (ROC) was utilized to assess the diagnostic efficacy of the predictors.

RESULTS

Among the 177 patients, 155 (87.5%) were males, 22 (12.5%) were females; the mean age was 49.97 ± 10.71 years. Among the predictors of early post-operative recurrence of highly-differentiated HCC were an unsmooth tumor margin and an incomplete/without tumor capsule (p = 0.037 and 0.033, respectively) whereas those of early post-operative recurrence of moderately-differentiated HCC were incomplete/without tumor capsule, peritumoral enhancement along with peritumoral hypointensity (p = 0.006, 0.046 and 0.004, respectively). The predictors of early post-operative recurrence of poorly-differentiated HCC were peritumoral enhancement, peritumoral hypointensity, and tumor thrombosis (p = 0.033, 0.006 and 0.021, respectively). The AUCs of the multi-predictor diagnosis of early post-operative recurrence of highly-, moderately-, and poorly-differentiated HCC were 0.841, 0.873, and 0.875, respectively. The AUCs of the multi-predictor diagnosis were each higher than for those predicted separately.

CONCLUSIONS

The imaging parameters for predicting early post-operative recurrence of HCC with different degrees of pathological differentiation were different and combining these predictors can improve the diagnostic efficacy of early post-operative HCC recurrence.

Diagnostic accuracy of contrast-enhanced ultrasound for microvascular invasion of hepatocellular carcinoma: A protocol for systematic review and meta-analysis

BACKGROUND

Microvascular invasion is an independent risk factor for the recurrence of hepatocellular carcinoma (HCC). Early detection and timely treatment can reduce the recurrence and prolong the overall survival of HCC. Contrast-enhanced ultrasound (CEUS) has been validated for their predictive potential of microvascular invasion in HCC patients, although the conclusion remains controversial. Therefore, a meta-analysis is necessary to be conducted to validate the diagnostic value of CEUS for microvascular invasion in HCC, thus supporting guideline development and clinical practice.

METHODS

Relevant studies reporting the potential diagnostic value of CEUS for microvascular invasion in HCC patients published before February 2022 will be searched in the PubMed, EMBASE, Cochrane Library, and Web of Science. Data will be extracted by 2 researchers independently. The risk of bias will be assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. All of the above statistical analysis will be carried out with Stata 14.0.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

This study will comprehensively evaluate the diagnostic accuracy of CEUS for microvascular invasion in HCC patients, thus providing high-quality evidence to support clinical practice and guideline development.