Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

doi:10.4251/wjgo.v16.i4.1192

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World Journal of Gastrointestinal Oncology

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1948-5204

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Retrospective Cohort Study

World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1192-1203
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1192

Table 1 Clinical data of hepatocellular carcinoma patients with early or non-early recurrence after resection, n (%)

Factors		Early recurrence, n = 73 (%)	Non-early recurrence, n = 88 (%)	χ²/t	P value
Age (yr)	-	53.47 ± 11.07	59.88 ± 9.76	-3.902	0.000^b
Serum albumin	-	40.43 ± 4.21	40.05 ± 5.27	0.501	0.617
Total bilirubin	-	17.24 ± 10.52	18.62 ± 8.84	-0.903	0.368
Gender	Male	62 (84.9)	80 (90.9)	1.370	0.242
	Female	11 (15.1)	8 (9.1)	-	-
Age (group)	> 50	43 (58.9)	76 (86.4)	17.679	0.000^b
	≤ 50	30 (41.1)	12 (13.6)	-	-
Hepatitis B	Positive	72 (98.6)	81 (92.0)	Fisher	0.073
	Negative	1 (1.4)	7 (8.0)	-	-
Cirrhosis	Present	40 (54.8)	50 (56.8)	0.066	0.797
	Absent	33 (45.2)	38 (43.8)	-	-
HBV-DNA	Negative	12 (16.4)	19 (21.6)	0.681	0.409
	Positive	61 (83.6)	69 (78.4)	-	-
AFP	> 100	44 (60.3)	30 (34.1)	11.013	0.001^b
	≤ 100	29 (39.7)	58 (65.9)	-	-
Child-Pugh score	A	68 (93.2)	74 (84.1)	3.146	0.076
	B	5 (6.8)	14 (15.9)	-	-
Portal hypertension	Present	23 (31.5)	27 (30.7)	0.013	0.910
	Absent	50 (68.5)	61 (69.3)	-	-
Operation mode	Local excision	21 (28.8)	34 (38.6)	2.261	0.133
	Anatomical excision	52 (71.2)	54 (61.4)	-	-
Postoperative HAIC	Present	13 (17.8)	11 (12.5)	0.886	0.346
	Absent	60 (82.2)	77 (87.5)	-	-
BCLC stage	0	3 (4.1)	9 (10.2)	26.919	0.000^b
	A	29 (39.7)	62 (70.5)	-	-
	B	15 (20.5)	11 (12.5)	-	-
	C	26 (35.6)	6 (6.8)	-	-
CNLC stage	I	31 (42.5)	72 (81.8)	29.060	0.000^b
	II	16 (21.9)	10 (11.4)	-	-
	III	26 (35.6)	6 (6.8)	-	-
Degree of pathological differentiation	Low	10 (13.7)	15 (17.0)	3.397	0.183
	Middle	62 (84.9)	67 (76.1)	-	-
	High	1 (1.4)	6 (6.8)	-	-
Pathological satellite focus	Present	15 (20.5)	6 (6.8)	6.631	0.010^b
	Absent	58 (79.5)	82 (93.2)	-	-
MVI	Present	39 (53.4)	17 (19.3)	20.461	0.000^b
	Absent	33 (46.6)	71 (80.7)

^bP < 0.01.

HBV: Hepatitis B virus; AFP: Alpha-fetoprotein; HAIC: Hepatic artery infusion chemotherapy; BCLC: Barcelona Clinic Liver Cancer; CNLC: China liver cancer; MVI: Microvascular invasion.

Table 2 Magnetic resonance imaging features in hepatocellular carcinoma patients with early or non-early recurrence after resection, n (%)

Factors		Early recurrence, n = 73 (%)	Non-early recurrence n = 88 (%)	χ²/t	P value
Max-diameter		6.85 ± 3.78	5.19 ± 3.52	2.918	0.004^b
Tumor SI/peritumoral SI		50.67 ± 12.20	57.63 ± 15.64	-3.097	0.002^b
Tumor numbers	Single	51 (69.9)	75 (85.2)	5.536	0.019^a
	Multiple	22 (30.1)	13 (14.8)
Tumor boundary	Regular	20 (27.4)	61 (69.3)	28.049	0.000^b
	Irregular	53 (72.6)	27 (30.7)
Portal vein tumor thrombus	Present	13 (17.8)	2 (2.3)	Fisher	0.001^b
	Absent	60 (82.2)	86 (97.7)
Large vessel invasion	Present	26 (35.6)	5 (5.7)	22.997	0.000^b
	Absent	47 (64.4)	83 (94.3)
Intratumoral hemorrhage	Present	23 (31.5)	16 (18.2)	3.860	0.049^a
	Absent	50 (68.5)	72 (81.8)
Intratumoral necrosis	Present	52 (71.2)	36 (40.9)	14.804	0.000^b
	Absent	21 (28.8)	52 (59.1)
Tumor steatosis	Present	6 (8.2)	15 (17.0)	2.741	0.098
	Absent	67 (91.8)	73 (83.0)
Tumor capsule	Intact	20 (27.4)	55 (62.5)	20.220	0.000^b
	Incomplete	42 (57.5)	24 (27.3)
	Lack	11 (15.1)	9 (10.2)
HBP peritumoral high uptake	Present	0 (0.0)	5 (5.7)	Fisher	0.064
	Absent	73 (100.0)	83 (94.3)
Nonrim arterial phase hyperenhancement	Present	73 (100.0)	86 (97.7)	Fisher	0.501
	Absent	0 (0.0)	2 (2.3)
Nonperipheral washout	Present	68 (93.2)	72 (81.8)	4.518	0.034^a
	Absent	5 (6.8)	16 (18.2)
Peritumoral enhancement	Present	18 (24.7)	9 (10.2)	5.953	0.015^a
	Absent	55 (75.3)	79 (89.9)
HBP peritumoral low signal	Present	26 (35.6)	7 (8.0)	18.736	0.000^b
	Absent	47 (64.4)	81 (92.0)
Peritumoral delay enhancement	Present	5 (6.8)	27 (30.7)	14.231	0.000^b
	Absent	68 (92.2)	61 (69.3)

^aP < 0.05.

^bP < 0.01.

SI: Signal intensity; HBP: Hepatobiliary phase.

Table 3 Univariate logistic regression analysis in hepatocellular carcinoma patients with early or non-early recurrence after resection

Factors	B	SE	Wald χ²	P value	HR	95%CI
Age (group)	1.486	0.391	14.422	0.000^b	4.419	2.052, 9.513
AFP	1.076	0.328	10.744	0.001^b	2.933	1.541, 5.582
BCLC stage			23.108	0.000^b
BCLC stage 1	0.339	0.704	0.232	0.6300	1.403	0.353, 5.572
BCLC stage 2	1.409	0.776	3.297	0.069	4.091	0.894, 18.718
BCLC stage 3	2.565	0.806	10.128	0.001^a	13.000	2.679, 63.093
CNLC stage			25.163	0.000^b
CNLC stage 1	1.313	0.457	8.259	0.004^b	3.716	1.518, 9.097
CNLC stage 1	2.309	0.501	21.218	0.000^b	10.065	3.768, 26.883
MVI	1.567	0.358	19.181	0.000^b	4.791	2.376, 9.658
Pathological satellite focus	1.263	0.513	6.066	0.014^b	3.534	1.294, 9.653
Tumor size	0.125	0.046	7.278	0.007^b	1.133	1.035, 1.241
Tumor numbers	0.912	0.394	5.352	0.021^a	2.489	1.149, 5.388
Tumor boundary	1.790	0.350	26.187	0.000^b	5.987	3.017, 11.882
Tumor capsule	0.581	0.247	5.549	0.018^a	1.788	1.103, 2.900
Intratumoral hemorrhage	0.728	0.374	3.784	0.052	2.070	0.995, 4.308
Intratumoral necrosis	1.274	0.337	14.265	0.000^b	3.577	1.846, 6.930
Portal vein tumor thrombus	2.232	0.778	8.230	0.004^b	9.317	2.028, 42.801
Large vessel invasion	2.217	0.521	18.090	0.000^b	9.183	3.305, 25.515
Nonperipheral washout	1.106	0.540	4.202	0.040^a	3.022	1.050, 8.701
Peritumoral enhancement	1.055	0.444	5.638	0.018^a	2.873	1.202, 6.864
HBP tumor SI/peritumoral SI	-0.035	0.012	8.688	0.003^b	0.965	0.943, 0.988
HBP peritumoral low signal	1.856	0.464	16.035	0.000^b	6.401	2.580, 15.882
Peritumoral delay enhancement	-1.795	0.518	12.017	0.001^b	0.166	0.060, 0.458

^aP < 0.05.

^bP < 0.01.

HR: Hazard ratio; 95%CI: 95% confidence interval; AFP: Alpha-fetoprotein; BCLC: Barcelona Clinic Liver Cancer; CNLC: China liver cancer; MVI: Microvascular invasion; SI: Signal intensity; HBP: Hepatobiliary phase.

Table 4 Multivariate logistic regression analysis to identify the predictors for early recurrence of hepatocellular carcinoma patients after operation

Factors	B	SE	Wald χ²	P value	HR	95%CI
Age (≤ 50 yr)	1.314	0.430	9.356	0.002^b	3.722	1.603, 8.641
MVI	0.828	0.422	3.846	0.050^a	2.288	1.001, 5.234
CNLC stage			12.193	0.002^b
Stage II	0.938	0.496	3.577	0.059	2.556	0.967, 6.757
Stage III	1.836	0.558	10.839	0.001^b	6.272	2.102, 18.712
Irregular shape	1.292	0.380	11.550	0.001^b	3.638	1.728, 7.663
Large vessel invasion	1.736	0.557	9.728	0.002^b	5.675	1.906, 16.896

^aP < 0.05.

^bP < 0.01.

HR: Hazard ratio; 95%CI: 95% confidence interval; CNLC: China liver cancer; MVI: Microvascular invasion.

Table 5 External validation of the predictors for early recurrence of hepatocellular carcinoma patients after operation

Factors	Sensitivity	Specificity	Accuracy	AUC	P value	95%CI
Age (≤ 50 yr)	0.500	0.882	0.710	0.691	0.071	0.496, 0.886
MVI	0.643	0.941	0.806	0.792	0.006	0.619, 0.965
CNLC stage (II-III)	0.571	0.941	0.774	0.756	0.015	0.574, 0.939
Irregular shape	0.643	0.824	0.742	0.733	0.028	0.548, 0.919
Large vessel invasion	0.500	0.941	0.742	0.721	0.037	0.530, 0.911
Combined multi-factors	0.786	0.941	0.871	0.861	0.001	0.717, 1.000

AUC: Area under the curve; 95%CI: 95% confidence interval; CNLC: China liver cancer; MVI: Microvascular invasion.

Citation: Chen JP, Yang RH, Zhang TH, Liao LA, Guan YT, Dai HY. Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection. World J Gastrointest Oncol 2024; 16(4): 1192-1203
URL: https://www.wjgnet.com/1948-5204/full/v16/i4/1192.htm
DOI: https://dx.doi.org/10.4251/wjgo.v16.i4.1192