Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection
Introduction: Microvascular invasion (MVI) is one of the most important prognostic factors for hepatocellular carcinoma (HCC) recurrence, but its application in preoperative clinical decisions is limited. This study aimed to identify preoperative predictive factors for MVI in HCC and further evaluat...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2023-07-01
|
| Series: | Liver Cancer |
| Subjects: | |
| Online Access: | https://beta.karger.com/Article/FullText/531786 |
| _version_ | 1797755664172318720 |
|---|---|
| author | Na Reum Kim Heejin Bae Hyeo Seong Hwang Dai Hoon Han Kyung Sik Kim Jin Sub Choi Mi-Suk Park Gi Hong Choi |
| author_facet | Na Reum Kim Heejin Bae Hyeo Seong Hwang Dai Hoon Han Kyung Sik Kim Jin Sub Choi Mi-Suk Park Gi Hong Choi |
| author_sort | Na Reum Kim |
| collection | DOAJ |
| description | Introduction: Microvascular invasion (MVI) is one of the most important prognostic factors for hepatocellular carcinoma (HCC) recurrence, but its application in preoperative clinical decisions is limited. This study aimed to identify preoperative predictive factors for MVI in HCC and further evaluate oncologic outcomes of different types and extents of hepatectomy according to stratified risk of MVI. Methods: Patients with surgically resected single HCC (≤5 cm) who underwent preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI) were included in a single-center retrospective study. Two radiologists reviewed the images with no clinical, pathological, or prognostic information. Significant predictive factors for MVI were identified using logistic regression analysis against pathologic MVI and used to stratify patients. In the subgroup analysis, long-term outcomes of the stratified patients were analyzed using the Kaplan-Meier method with log-rank test and compared between anatomical and nonanatomical or major and minor resection. Results: A total of 408 patients, 318 men and 90 women, with a mean age of 56.7 years were included. Elevated levels of tumor markers (alpha-fetoprotein [α-FP] ≥25 ng/mL and PIVKA-II ≥40 mAU/mL) and three MRI features (tumor size ≥3 cm, non-smooth tumor margin, and arterial peritumoral enhancement) were independent predictive factors for MVI. As the MVI risk increased from low (no predictive factor) and intermediate (1–2 factors) to high-risk (3–4 factors), recurrence-free and overall survival of each group significantly decreased (p = 0.001). In the high MVI risk group, 5-year cumulative recurrence rate was significantly lower in patients who underwent major compared to minor hepatectomy (26.6 vs. 59.8%, p = 0.027). Conclusion: Tumor markers and MRI features can predict the risk of MVI and prognosis after hepatectomy. Patients with high MVI risk had the worst prognosis among the three groups, and major hepatectomy improved long-term outcomes in these high-risk patients. |
| first_indexed | 2024-03-12T17:49:23Z |
| format | Article |
| id | doaj.art-43db3afbd60a48029b96e3c7509250b4 |
| institution | Directory Open Access Journal |
| issn | 1664-5553 |
| language | English |
| last_indexed | 2024-03-12T17:49:23Z |
| publishDate | 2023-07-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Liver Cancer |
| spelling | doaj.art-43db3afbd60a48029b96e3c7509250b42023-08-03T09:10:10ZengKarger PublishersLiver Cancer1664-55532023-07-011110.1159/000531786531786Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver ResectionNa Reum Kim0https://orcid.org/0000-0001-7268-8543Heejin Bae1Hyeo Seong Hwang2Dai Hoon Han3Kyung Sik Kim4Jin Sub Choi5Mi-Suk Park6Gi Hong Choi7https://orcid.org/0000-0002-1593-3773Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Seoul, Republic of KoreaDepartment of Surgery, Yonsei University College of Medicine, Seoul, Republic of KoreaDepartment of Surgery, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Seoul, Republic of KoreaDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Seoul, Republic of KoreaDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Seoul, Republic of KoreaDepartment of Surgery, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Seoul, Republic of KoreaIntroduction: Microvascular invasion (MVI) is one of the most important prognostic factors for hepatocellular carcinoma (HCC) recurrence, but its application in preoperative clinical decisions is limited. This study aimed to identify preoperative predictive factors for MVI in HCC and further evaluate oncologic outcomes of different types and extents of hepatectomy according to stratified risk of MVI. Methods: Patients with surgically resected single HCC (≤5 cm) who underwent preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI) were included in a single-center retrospective study. Two radiologists reviewed the images with no clinical, pathological, or prognostic information. Significant predictive factors for MVI were identified using logistic regression analysis against pathologic MVI and used to stratify patients. In the subgroup analysis, long-term outcomes of the stratified patients were analyzed using the Kaplan-Meier method with log-rank test and compared between anatomical and nonanatomical or major and minor resection. Results: A total of 408 patients, 318 men and 90 women, with a mean age of 56.7 years were included. Elevated levels of tumor markers (alpha-fetoprotein [α-FP] ≥25 ng/mL and PIVKA-II ≥40 mAU/mL) and three MRI features (tumor size ≥3 cm, non-smooth tumor margin, and arterial peritumoral enhancement) were independent predictive factors for MVI. As the MVI risk increased from low (no predictive factor) and intermediate (1–2 factors) to high-risk (3–4 factors), recurrence-free and overall survival of each group significantly decreased (p = 0.001). In the high MVI risk group, 5-year cumulative recurrence rate was significantly lower in patients who underwent major compared to minor hepatectomy (26.6 vs. 59.8%, p = 0.027). Conclusion: Tumor markers and MRI features can predict the risk of MVI and prognosis after hepatectomy. Patients with high MVI risk had the worst prognosis among the three groups, and major hepatectomy improved long-term outcomes in these high-risk patients.https://beta.karger.com/Article/FullText/531786hepatocellular carcinomamicroscopic vascular invasionmagnetic resonance imaginghepatectomyrecurrence |
| spellingShingle | Na Reum Kim Heejin Bae Hyeo Seong Hwang Dai Hoon Han Kyung Sik Kim Jin Sub Choi Mi-Suk Park Gi Hong Choi Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection Liver Cancer hepatocellular carcinoma microscopic vascular invasion magnetic resonance imaging hepatectomy recurrence |
| title | Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection |
| title_full | Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection |
| title_fullStr | Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection |
| title_full_unstemmed | Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection |
| title_short | Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Single Hepatocellular Carcinoma: The Implication of Surgical Decision on the Extent of Liver Resection |
| title_sort | preoperative prediction of microvascular invasion with gadoxetic acid enhanced magnetic resonance imaging in patients with single hepatocellular carcinoma the implication of surgical decision on the extent of liver resection |
| topic | hepatocellular carcinoma microscopic vascular invasion magnetic resonance imaging hepatectomy recurrence |
| url | https://beta.karger.com/Article/FullText/531786 |
| work_keys_str_mv | AT nareumkim preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT heejinbae preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT hyeoseonghwang preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT daihoonhan preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT kyungsikkim preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT jinsubchoi preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT misukpark preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection AT gihongchoi preoperativepredictionofmicrovascularinvasionwithgadoxeticacidenhancedmagneticresonanceimaginginpatientswithsinglehepatocellularcarcinomatheimplicationofsurgicaldecisionontheextentofliverresection |