Prognostic significance of the liver stiffness value on magnetic resonance imaging elastography in patients undergoing hepatectomy for hepatocellular carcinoma.

Abstract

Synopsis: This study shows the utility of magnetic resonance imaging elastography as an independent predictor of the postoperative recurrence of hepatocellular carcinoma.

Purpose: Accurate assessment of postoperative recurrence risk is crucial for the perioperative management of patients undergoing surgical resection for hepatocellular carcinoma (HCC). Magnetic resonance imaging elastography (MRE) has emerged as a noninvasive tool for assessing liver fibrosis. This study evaluated whether MRE independently predicts HCC recurrence more effectively than well-known oncological factors, including pathological findings.

Methods: The subjects of this retrospective observational study were HCC patients who underwent preoperative MRE and hepatectomy between 2013 and 2023. Data collected included demographics, laboratory findings, imaging, pathology, operative details, and prognosis. Patients were followed up for at least 1 year after hepatectomy or until recurrence.

Results: Recurrence developed in 46 of 100 patients. Multivariable Cox regression analysis for overall recurrence identified MRE ≥ 3.7 kPa (hazard ratio [HR] 3.161, p = 0.021), the FIB-4 index (HR 3.176, p = 0.001), tumor size > 5 cm (HR 5.893, p < 0.001), invasive growth pattern (HR 2.375, p = 0.036), METAVIR F3-4 (HR 2.562, p = 0.046), and venous invasion (HR 10.622, p < 0.001) as risk factors. The recurrence-free rate at 1 year for patients with MRE ≥ 3.7 kPa was lower than for those with MRE < 3.7 kPa (72.0% vs. 92.0%, p = 0.017).

Conclusions: Preoperative MRE predicts postoperative HCC recurrence, underscoring its utility in risk stratification.