MRI-based prediction of microvascular invasion/high tumor grade and adjuvant therapy benefit for solitary HCC ≤ 5 cm: a multicenter cohort study.

IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
European Radiology Pub Date : 2025-06-01 Epub Date: 2024-12-19 DOI:10.1007/s00330-024-11295-1
Hanyu Jiang, Binrong Li, Tianying Zheng, Yun Qin, Yuanan Wu, Zhenru Wu, Maxime Ronot, Victoria Chernyak, Kathryn J Fowler, Mustafa R Bashir, Weixia Chen, Yuan-Cheng Wang, Shenghong Ju, Bin Song
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引用次数: 0

Abstract

Objectives: To develop and externally validate an MRI-based diagnostic model for microvascular invasion (MVI) or Edmondson-Steiner G3/4 (i.e., high-risk histopathology) in solitary BCLC 0/A hepatocellular carcinoma (HCC) ≤ 5 cm and to assess its performance in predicting adjuvant therapy benefits.

Materials and methods: This multicenter retrospective cohort study included 577 consecutive adult patients who underwent contrast-enhanced MRI and subsequent curative resection or ablation for solitary BCLC 0/A HCC ≤ 5 cm (December 2011 to January 2024) from four hospitals. For resection-treated patients, a diagnostic model integrating clinical and 50 semantic MRI features was developed against pathology with logistic regression analyses on the training set (center 1) and externally validated on the testing dataset (centers 2-4), with its utilities in predicting posttreatment recurrence-free survival (RFS) and adjuvant therapy benefit evaluated by Cox regression analyses.

Results: Serum α-fetoprotein > 100 ng/mL (odds ratio (OR), 1.94; p = 0.006), non-simple nodular growth subtype (OR, 1.69; p = 0.03), and the VICT2 trait (OR, 4.49; p < 0.001) were included in the MVI or high-grade (MHG) trait, with testing set AUC, sensitivity, and specificity of 0.832, 74.0%, and 82.5%, respectively. In the multivariable Cox analysis, the MHG-positive status was associated with worse RFS (resection testing set HR, 3.55, p = 0.02; ablation HR, 3.45, p < 0.001), and adjuvant therapy was associated with improved RFS only for the MHG-positive patients (resection HR, 0.39, p < 0.001; ablation HR, 0.30, p = 0.005).

Conclusion: The MHG trait effectively predicted high-risk histopathology, RFS and adjuvant therapy benefit among patients receiving curative resection or ablation for solitary BCLC 0/A HCC ≤ 5 cm.

Key points: Question Despite being associated with increased recurrence and potential benefit from adjuvancy in HCC, microvascular invasion or Edmondson-Steiner grade 3/4 are hardly assessable noninvasively. Findings We developed and externally validated an MRI-based model for predicting high-risk histopathology, post-resection/ablation recurrence-free survival, and adjuvant therapy benefit in solitary HCC ≤ 5 cm. Clinical relevance Among patients receiving curative-intent resection or ablation for solitary HCC ≤ 5 cm, noninvasive identification of high-risk histopathology (MVI or high-grade) using our proposed MRI model may help improve individualized prognostication and patient selection for adjuvant therapies.

一项多中心队列研究:基于mri的单发≤5 cm HCC微血管侵袭/高肿瘤分级及辅助治疗获益预测
目的开发并从外部验证基于MRI的微血管侵犯(MVI)或Edmondson-Steiner G3/4(即高危组织病理学)诊断模型,用于诊断≤5 cm的单发BCLC 0/A肝细胞癌(HCC),并评估其在预测辅助治疗效果方面的性能:这项多中心回顾性队列研究纳入了来自四家医院的577例连续成人患者,这些患者因单发BCLC 0/A 肝细胞癌≤5厘米接受了造影剂增强MRI检查和随后的根治性切除术或消融术(2011年12月至2024年1月)。对于接受切除治疗的患者,通过对训练集(中心1)进行逻辑回归分析,针对病理学建立了一个整合了临床和50个语义MRI特征的诊断模型,并在测试数据集(中心2-4)上进行了外部验证,通过Cox回归分析评估了该模型在预测治疗后无复发生存期(RFS)和辅助治疗获益方面的效用:结果:血清α-胎儿蛋白>100 ng/mL(几率比(OR),1.94;P = 0.006)、非单纯结节生长亚型(OR,1.69;P = 0.03)和VICT2特质(OR,4.49;P 结论:MHG特质可有效预测治疗后无复发生存期(RFS)和辅助治疗获益:MHG特质可有效预测因单发BCLC 0/A HCC ≤ 5 cm而接受根治性切除或消融术的患者的高风险组织病理学、RFS和辅助治疗获益:问题 尽管微血管侵犯或Edmondson-Steiner 3/4级与HCC复发率增加和辅助治疗的潜在获益有关,但很难通过无创方法进行评估。研究结果 我们开发了一种基于 MRI 的模型,用于预测 5 厘米以下单发 HCC 的高危组织病理学、切除/消融术后无复发生存率和辅助治疗获益,该模型已经过外部验证。临床意义 在接受根治性切除术或消融术的单发≤5厘米HCC患者中,使用我们提出的MRI模型对高危组织病理学(MVI或高级别)进行无创鉴定,可能有助于改善个体化预后和患者辅助治疗的选择。
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来源期刊
European Radiology
European Radiology 医学-核医学
CiteScore
11.60
自引率
8.50%
发文量
874
审稿时长
2-4 weeks
期刊介绍: European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.
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