Preoperative Prediction for Early Recurrence Can Be as Accurate as Postoperative Assessment in Single Hepatocellular Carcinoma Patients

Abstract

Objective: To evaluate the performance of predicting early recurrence using preoperative factors only in comparison with using both pre-/postoperative factors. Materials and Methods: We retrospectively reviewed 549 patients who had undergone curative resection for single hepatcellular carcinoma (HCC) within Milan criteria. Multivariable analysis was performed to identify pre-/postoperative highrisk factors of early recurrence after hepatic resection for HCC. Two prediction models for early HCC recurrence determined by stepwise variable selection methods based on Akaike information criterion were built, either based on preoperative factors alone or both pre-/postoperative factors. Area under the curve (AUC) for each receiver operating characteristic curve of the two models was calculated, and the two curves were compared for non-inferiority testing. The predictive models of early HCC recurrence were internally validated by bootstrap resampling method. Results: Multivariable analysis on preoperative factors alone identified aspartate aminotransferase/platelet ratio index (OR, 1.632; 95% CI, 1.056-2.522; p = 0.027), tumor size (OR, 1.025; 95% CI, 0.002-1.049; p = 0.031), arterial rim enhancement of the tumor (OR, 2.350; 95% CI, 1.297-4.260; p = 0.005), and presence of nonhypervascular hepatobiliary hypointense nodules (OR, 1.983; 95% CI, 1.049-3.750; p = 0.035) on gadoxetic acid-enhanced magnetic resonance imaging as significant factors. After adding postoperative histopathologic factors, presence of microvascular invasion (OR, 1.868; 95% CI, 1.155-3.022; p = 0.011) became an additional significant factor, while tumor size became insignificant (p = 0.119). Comparison of the AUCs of the two models showed that the prediction model built on preoperative factors alone was not inferior to that including both pre-/postoperative factors {AUC for preoperative factors only, 0.673 (95% confidence interval [CI], 0.623-0.723) vs. AUC after adding postoperative factors, 0.691 (95% CI, 0.639-0.744); p = 0.0013}. Bootstrap resampling method showed that both the models were valid. Conclusion: Risk stratification solely based on preoperative imaging and laboratory factors was not inferior to that based on postoperative histopathologic risk factors in predicting early recurrence after curative resection in within Milan criteria single HCC patients.

Value of gadoxetic acid-enhanced MRI for microvascular invasion of small hepatocellular carcinoma: a retrospective study

“…Secondly, owing to the high performance of radiomics in the stable calculation, repeatability, indefatigability, and no interference of human subjectivity. Our research made a much higher SE and SP than those ever reported [39][40][41][42]. Thirdly, we extracted almost the whole sHCC features on HBP, including the three-dimensional features (e.g., morphology and smoothness), making the study much more credible and representative.…”

LI-RADS category 5 hepatocellular carcinoma: preoperative gadoxetic acid–enhanced MRI for early recurrence risk stratification after curative resection

“…The sensitivity, specificity, PPV, NPV, and accuracy of each indicator predictive of early recurrence are summarized in Table 3 . In addition, preoperative gadoxetic acid–enhanced MR imaging features for predicting early recurrence of HCC after surgical resection in published studies [ 7 – 9 , 12 , 18 – 22 ] are shown in Table 4 .…”

“…The LI-RADS major features (except for threshold growth) and ancillary features (except for corona enhancement), and other non-LIRADS imaging features reported to be correlated with postoperative recurrence, such as tumor size [ 9 , 18 , 22 ], multiple tumors [ 10 , 29 , 30 ], non-smooth tumor margin [ 8 , 10 , 12 , 19 , 20 ], and incomplete tumor capsule [ 31 ], did not show significant associations with early recurrence in our study. However, as reported in a recent study, the absence of fat in mass (one LI-RADS ancillary features favoring HCC in particular) was an independent predictor for recurrence in patients with LR-5 HCC [ 10 ].…”

“…As opposed to most previous studies in which patients were classified into two subgroups (low and high risk) according to their risk of recurrence [7,9,10,[18][19][20][21][22], herein, we identified a fraction of medium-risk patients by stratifying LR-5 HCC patients into three subcategories with significantly different early recurrence rate and disease-free survival. Although Qin X et al stratified HCC patients into three subgroups with low, medium, and high recurrence rate by using the parameters of T1 mapping, the recurrence rates were not significantly different between subgroups of high-and medium-risk of recurrence in that study [23].…”

Magnetic resonance elastography can predict the development of hepatocellular carcinoma: a meta-analysis and systematic review

“…summarizes the total number of patients. Relevant data were extracted from nine papers(16)(17)(18)(19)(20)(21)(22)(23)(24), including the first author's name, year of publication, country, gender distribution (male/female), sample size, age range, and…”