Diagnostic Model for Proliferative HCC Using LI-RADS: Assessing Therapeutic Outcomes in Hepatectomy and TKI-ICI Combination

Mengtian Lu; Zuyi Yan; Qi Qu; Guodong Zhu; Lei Xu; Maotong Liu; Jifeng Jiang; Chunyan Gu; Ying Chen; Tao Zhang; Xueqin Zhang

doi:10.1002/jmri.29400

Diagnostic Model for Proliferative HCC Using LI-RADS: Assessing Therapeutic Outcomes in Hepatectomy and TKI-ICI Combination

J Magn Reson Imaging. 2024 Apr 22. doi: 10.1002/jmri.29400. Online ahead of print.

Authors

Mengtian Lu^{1

2}, Zuyi Yan^{1

2}, Qi Qu^{1

2}, Guodong Zhu³, Lei Xu², Maotong Liu², Jifeng Jiang², Chunyan Gu⁴, Ying Chen², Tao Zhang², Xueqin Zhang²

Affiliations

¹ Nantong University, Nantong, Jiangsu, China.
² Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China.
³ Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China.
⁴ Department of Pathology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China.

PMID: 38647041
DOI: 10.1002/jmri.29400

Abstract

Background: Proliferative hepatocellular carcinoma (HCC), aggressive with poor prognosis, and lacks reliable MRI diagnosis.

Purpose: To develop a diagnostic model for proliferative HCC using liver imaging reporting and data system (LI-RADS) and assess its prognostic value.

Study type: Retrospective.

Population: 241 HCC patients underwent hepatectomy (90 proliferative HCCs: 151 nonproliferative HCCs), divided into the training (N = 167) and validation (N = 74) sets. 57 HCC patients received combination therapy with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).

Field strength/sequence: 3.0 T, T1- and T2-weighted, diffusion-weighted, in- and out-phase, T1 high resolution isotropic volume excitation and dynamic gadoxetic acid-enhanced imaging.

Assessment: LI-RADS v2018 and other MRI features (intratumoral artery, substantial hypoenhancing component, hepatobiliary phase peritumoral hypointensity, and irregular tumor margin) were assessed. A diagnostic model for proliferative HCC was established, stratifying patients into high- and low-risk groups. Follow-up occurred every 3-6 months, and recurrence-free survival (RFS), progression-free survival (PFS) and overall survival (OS) in different groups were compared.

Statistical tests: Fisher's test or chi-square test, t-test or Mann-Whitney test, logistic regression, Harrell's concordance index (C-index), Kaplan-Meier curves, and Cox proportional hazards. Significance level: P < 0.05.

Results: The diagnostic model, incorporating corona enhancement, rim arterial phase hyperenhancement, infiltrative appearance, intratumoral artery, and substantial hypoenhancing component, achieved a C-index of 0.823 (training set) and 0.804 (validation set). Median follow-up was 32.5 months (interquartile range [IQR], 25.1 months) for postsurgery patients, and 16.8 months (IQR: 13.2 months) for combination-treated patients. 99 patients experienced recurrence, and 30 demonstrated tumor nonresponse. Differences were significant in RFS and OS rates between high-risk and low-risk groups post-surgery (40.3% vs. 65.8%, 62.3% vs. 90.1%, at 5 years). In combination-treated patients, PFS rates differed significantly (80.6% vs. 7.7% at 2 years).

Data conclusion: The MR-based model could pre-treatment identify proliferative HCC and assist in prognosis evaluation.

Technical efficacy: Stage 2.

Keywords: diagnosis; hepatocellular carcinoma; liver imaging reporting and data system.

Abstract

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