A computed tomography radiogenomic biomarker predicts microvascular invasion and clinical outcomes in hepatocellular carcinoma.
A computed tomography radiogenomic biomarker predicts microvascular invasion and clinical outcomes in hepatocellular carcinoma.
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DOI：
10.1002/hep.27877
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Kuo MD
中科院分区：
文献类型：
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作者：
Banerjee S;Wang DS;Kim HJ;Sirlin CB;Chan MG;Korn RL;Rutman AM;Siripongsakun S;Lu D;Imanbayev G;Kuo MD
肝细胞癌（HCC）的微血管侵袭（MVI）是手术切除或肝移植（LT）后不良预后的独立预测因子；然而，目前术前不能充分确定MVI。放射基因组静脉侵入（RVI）是一种对比增强的计算机断层扫描（CECT）生物标志物，来自91个基因的HCC“静脉侵入”基因表达特征。在2000年至2009年期间，在三家机构接受手术切除（N = 72）或肝移植（N = 85）的157例HCC患者的术前cect被评估是否存在RVI。评估RVI预测MVI和预后的能力。5名放射科医生对RVI评分的观察者间一致性显著（κ = 0.705; P < 0.001）。RVI预测MVI的诊断准确性、敏感性和特异性分别为89%、76%和94%。在整个队列中，RVI评分阳性的总生存期（OS）低于RVI评分阴性的总生存期（OS） （P < 0.001； 48个月vs. >47个月），美国癌症联合委员会肿瘤-淋巴结转移期II期（P < 0.001； 34个月vs. >147个月），以及米兰标准的LT患者（P < 0.001； 69个月vs. >47个月）。与RVI评分阴性相比，RVI评分阳性也预示着3年无复发生存率较低（P = 0.001； 27%对62%）。结论：RVI是一种无创放射基因组生物标志物，可准确预测HCC手术候选人的组织学MVI。术前CECT中出现该肿瘤与早期疾病复发和不良OS相关，可能有助于识别不太可能从手术治疗中获得持久益处的患者。(肝脏病学62:792 2015;800)
Microvascular invasion (MVI) in hepatocellular carcinoma (HCC) is an independent predictor of poor outcomes subsequent to surgical resection or liver transplantation (LT); however, MVI currently cannot be adequately determined preoperatively. Radiogenomic venous invasion (RVI) is a contrast-enhanced computed tomography (CECT) biomarker of MVI derived from a 91-gene HCC “venous invasion” gene expression signature. Preoperative CECTs of 157 HCC patients who underwent surgical resection (N = 72) or LT (N = 85) between 2000 and 2009 at three institutions were evaluated for the presence or absence of RVI. RVI was assessed for its ability to predict MVI and outcomes. Interobserver agreement for scoring RVI was substantial among five radiologists (κ = 0.705; P < 0.001). The diagnostic accuracy, sensitivity, and specificity of RVI in predicting MVI was 89%, 76%, and 94%, respectively. Positive RVI score was associated with lower overall survival (OS) than negative RVI score in the overall cohort (P < 0.001; 48 vs. >147 months), American Joint Committee on Cancer tumor-node-metastasis stage II (P < 0.001; 34 vs. >147 months), and in LT patients within Milan criteria (P < 0.001; 69 vs. >147 months). Positive RVI score also portended lower recurrence-free survival at 3 years versus negative RVI score (P = 0.001; 27% vs. 62%). Conclusion: RVI is a noninvasive radiogenomic biomarker that accurately predicts histological MVI in HCC surgical candidates. Its presence on preoperative CECT is associated with early disease recurrence and poor OS and may be useful for identifying patients less likely to derive a durable benefit from surgical treatment. (Hepatology 2015;62:792–800)