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Predicting post-resection recurrence by integrating imaging-based surrogates of distinct vascular patterns of hepatocellular carcinoma

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机构: [1]Med Sch Southeast Univ, Zhongda Hosp, Dept Radiol, Jiangsu Key Lab Mol & Funct Imaging, Nanjing, Peoples R China [2]Jiangnan Univ, Dept Hepatobiliary Surg, Med Ctr, Wuxi, Peoples R China [3]Southeast Univ, Dept Radiol, Xuzhou Ctr Hosp, Xuzhou, Peoples R China [4]Cent South Univ, Dept Radiol, Xiangya Hosp, Changsha, Peoples R China [5]Kunming Med Univ, Pancreat Ctr, Dept Hepat Biliary, Affiliated Hosp 1, Kunming, Peoples R China [6]Zhejiang Univ, Affiliated Hosp 1, Coll Med, Dept Radiol, Hangzhou, Peoples R China [7]Nanjing Med Univ, Dept Radiol, Affiliated Wuxi Peoples Hosp, Wuxi, Peoples R China [8]Southeast Univ, Zhongda Hosp, Dept Radiol, Jiangsu Key Lab Mol & Funct Imaging,Med Sch, 87 Dingjiaqiao Rd, Nanjing 210009, Peoples R China
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关键词: Hepatocellular carcinoma Liver resection Microvascular invasion Modelling Recurrence

摘要:
Background & Aims: Distinct vascular patterns, including microvascular invasion (MVI) and vessels encapsulating tumour clusters (VETC), are associated with poor outcomes of hepatocellular carcinoma (HCC). Imaging surrogates of these vascular patterns potentially help to predict post-resection recurrence. Herein, a prognostic model integrating imaging-based surrogates of these distinct vascular patterns was developed to predict postoperative recurrence-free survival (RFS) in patients with HCC. Methods: Clinico-radiological data of 1,285 patients with HCC from China undergoing surgical resection were retrospectively enrolled from seven medical centres between 2014 and 2020. A prognostic model using clinical data and imaging-based surrogates of MVI and VETC patterns was developed (n = 297) and externally validated (n = 373) to predict RFS. The surrogates (i.e. MVI and VETC scores) were individually built from preoperative computed tomography using two independent cohorts (n = 360 and 255). Whether the model's stratification was associated with postoperative recurrence following anatomic resection was also evaluated. Results: The MVI and VETC scores demonstrated effective performance in their respective training and validation cohorts (AUC: 0.851-0.883 for MVI and 0.834-0.844 for VETC). The prognostic model incorporating serum alpha-foetoprotein, tumour multiplicity, MVI score, and VETC score achieved a C-index of 0.748-0.764 for the developing and external validation cohorts and generated three prognostically distinct strata. For patients at model-predicted medium risk, anatomic resection was associated with improved RFS (p <0.05). By contrast, anatomic resection had no impact on RFS in patients at model-predicted low or high risk (both p >0.05). Conclusions: The proposed model integrating imaging-based surrogates of distinct vascular patterns enabled accurate prediction for RFS. It can potentially be used to identify HCC surgical candidates who may benefit from anatomic resection. Impact and implications: MVI and VETC are distinct vascular patterns of HCC associated with aggressive biological behaviour and poor outcomes. Our multicentre study provided a model incorporating imaging-based surrogates of these patterns for preoperatively predicting RFS. The proposed model, which uses imaging detection to estimate the risk of MVI and VETC, offers an opportunity to help shed light on the association between tumour aggressiveness and prognosis and to support the selection of the appropriate type of surgical resection. & COPY; 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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大类 | 1 区 医学
小类 | 2 区 胃肠肝病学
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出版当年[2023]版:
Q1 GASTROENTEROLOGY & HEPATOLOGY
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Q1 GASTROENTEROLOGY & HEPATOLOGY

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第一作者机构: [1]Med Sch Southeast Univ, Zhongda Hosp, Dept Radiol, Jiangsu Key Lab Mol & Funct Imaging, Nanjing, Peoples R China
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通讯机构: [1]Med Sch Southeast Univ, Zhongda Hosp, Dept Radiol, Jiangsu Key Lab Mol & Funct Imaging, Nanjing, Peoples R China [8]Southeast Univ, Zhongda Hosp, Dept Radiol, Jiangsu Key Lab Mol & Funct Imaging,Med Sch, 87 Dingjiaqiao Rd, Nanjing 210009, Peoples R China
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