Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MRI: Risk of HCC recurrence after radiofrequency ablation
Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MRI: Risk of HCC recurrence after radiofrequency ablation
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DOI：
10.1016/j.jhep.2014.12.015
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发表时间：
2015-05-01
影响因子：
25.7
通讯作者：
Choi, Byung Ihn
中科院分区：
文献类型：
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作者：
Lee, Dong Ho;Lee, Jeong Min;Choi, Byung Ihn
背景和目标：钆塞酸增强MRI的肝胆期图像（HBPI）可以描述边界肝细胞结节，这些结节有可能进展为多血管肝细胞癌（HCC），如非多血管低信号结节。我们回顾性评估了钆塞酸增强MRI的HBPI处非富血管低信号结节的存在对早期肝癌射频消融（RFA）后患者预后的影响。方法：共纳入139名接受术前钆塞酸增强MRI然后进行RFA的患者。平均随访44.6 +/- 13.2个月后，我们比较了HBPI上存在非富血管低信号结节的肿瘤复发以及总体和无复发生存率（RFS）的结果：HBPI上存在非富血管低信号结节并不影响总体生存率（p = 0.136）。然而，在HBPI上无非富血管低信号结节的29例患者中，估计的5年RFS率为71.3%，而在HBPI上有非富血管低信号结节的110例患者中，估计的5年RFS率为27.9%，表明存在显著差异（风险比= 2.84 [1.39-5.98]，p = 0.006）。当我们将复发分为局部肿瘤进展[LTP]、肝内远处复发[IDR]和肝外转移[EM]时，在HBPI上有非富血管低信号结节的患者中，IDR的5年累积发生率（CI）显著高于在HBPI上没有非富血管低信号结节的患者（17.9% vs. 67.5%，p < 0.001）。LTP和EM的5年CI显示无显著差异（p > 0.05）。结论：RFA前钆塞酸增强MRI的HBPI上非富血管低信号肝细胞结节的存在是早期HCC RFA后复发的重要预测因素，尤其是IDR。(C)2014年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Hepatobiliary phase images (HBPI) of gadoxetic acid-enhanced MRI can depict borderline hepatocellular nodules that have the potential to progress into hypervascular hepatocellular carcinomas (HCCs), as non-hypervascular hypointense nodules. We retrospectively evaluated the impact of the presence of non-hypervascular hypointense nodules at HBPI of gadoxetic acid-enhanced MRI on the patient's prognosis after radiofrequency ablation (RFA) for early stage HCCs.Methods: A total of 139 patients who underwent pre-procedural gadoxetic acid-enhanced MRI followed by RFA were included. After a mean follow-up of 44.6 +/- 13.2 months, we compared the results of tumor recurrence as well as overall and recurrence-free survival (RFS) with the presence of non-hypervascular hypointense nodules on HBPI.Results: The presence of non-hypervascular hypointense nodules on HBPI did not affect overall survival (p = 0.136). However, the estimated 5-year RFS rate was 71.3% in 29 patients without non-hypervascular hypointense nodules on HBPI compared to 27.9% in 110 patients with non-hypervascular hypointense nodules on HBPI, indicating a significant difference (hazard ratio = 2.84 [1.39-5.98], p = 0.006). When we classified recurrence into local tumor progression [LTP], intrahepatic distant recurrence [IDR], and extra-hepatic metastasis [EM], five-year cumulative incidences (CI) of IDR in patients with non-hypervascular hypointense nodules on HBPI were significantly higher than those in patients without non-hypervascular hypointense nodules on HBPI (17.9% vs. 67.5%, p < 0.001). Five-year CIs of LTP and EM showed no significant difference (p > 0.05).Conclusions: The presence of non-hypervascular hypointense hepatocellular nodules on HBPI of gadoxetic acid-enhanced MRI taken prior to RFA is a significant predictive factor of recurrence after RFA of early stage HCCs, particularly IDR. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.