Complete tumor encapsulation on magnetic resonance imaging: A potentially useful imaging biomarker for better survival in solitary large hepatocellular carcinoma

Abstract

The aim of this study was to determine the prognostic value of complete tumor encapsulation as visualized on magnetic resonance imaging (MRI) in patients with a solitary large hepatocellular carcinoma (HCC) beyond the Milan criteria for liver transplantation (LT). Between December 2000 and March 2011, 57 patients who had a solitary HCC exceeding 5 cm in diameter at the time of initial MRI before any treatment were identified. MRI images of the patients were independently reviewed by 2 experienced readers for the presence of complete tumoral encapsulation. The medical records of the patients were reviewed for an outcome analysis. Thirty of the 57 patients had completely encapsulated HCC according to MRI. There was excellent interobserver agreement between the 2 readers for the assessment of complete encapsulation (j50.86). Overall survival was significantly longer for patients with completely encapsulated HCC versus patients with incompletely or nonencapsulated tumors (P<0.001), and this included a subanalysis of 33 patients who received locoregional treatment (LRT; P50.04). The presence of complete encapsulation was a strong predictor for survival in these patients according to both univariate [hazard ratio (HR)50.24, 95% confidence interval (CI)50.12-0.52, P<0.001] and multivariate analyses (HR50.25, 95% CI50.07-0.85, P50.03). The rates of down-staging (P<0.001) and eventual LT (P50.02) after LRT were also significantly higher in the patients with completely encapsulated tumors. In conclusion, complete tumor encapsulation on MRI is a potentially useful predictor for favorable biology in patients with a solitary large HCC. This new imaging biomarker may have a role in treatment selection for patients whose tumors exceed the Milan criteria size limits.

Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus

“…A lack of tumour encapsulation is another risk factor. It was shown in a recent study that complete tumour encapsulation predicted better OS, a better response to downstaging therapy and eventual liver transplantation . Last but not least, macrovascular invasion to the main portal vein or its branches was seen in 9 of the 37 patients.…”

Propensity‐Matched Analysis of Patients with Mixed Hepatocellular‐Cholangiocarcinoma and Hepatocellular Carcinoma Undergoing Liver Transplantation†

“…Of the 12 patients, 6 had digitized radiographic imaging available for review, compared with the detailed radiographic reports available for the remaining 6 patients. Of 7 lesions in these 6 patients, all demonstrated infiltrative margins and none were encapsulated . A heterogeneous or mosaic pattern of enhancement was noted in 6/7 lesions (85.7%) with 3/7 (42.9%) lesions meeting OPTN 5 criteria, thus resulting in the mistaken diagnosis of HCC by imaging criteria alone (Fig.…”

Tumor growth rates and recurrence-free survival in chronic viral hepatitis patients with hepatocellular carcinoma

“…Using MRI, one report showed that patients with fat-containing HCC had less tumor progression, less distant metastases, and a longer time to tumor progression when compared to patients with non-fat containing HCC [16] . Another report showed that patients with complete tumor encapsulation on MRI had lower AFP levels, an absence of vascular invasion, more patients in Child-Pugh class A, and significantly longer survivals [17] . Further, the authors also noted that the rates of downstaging and eventual liver transplantation were significantly higher.…”