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Liver stiffness measured by MR elastography is a predictor of early HCC recurrence after treatment

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Abstract

Objectives

Magnetic resonance elastography (MRE) is a non-invasive tool for measuring liver stiffness (LS) with high diagnostic accuracy. This study investigated whether quantified LS by MRE could predict early recurrence of patients with hepatocellular carcinoma (HCC) within the Milan criteria.

Methods

A prospectively collected cohort, which included the HCC patients who underwent MRE before treatment (an HCC-MRE cohort), was analyzed. In the HCC-MRE cohort, only patients under the Milan criteria, who underwent hepatic resection, radiofrequency ablation (RFA), or transarterial chemoembolization (TACE), were reviewed. We investigated whether LS assessed by MRE was an independent predictor of early recurrence using Cox regressions and Kaplan-Meier analyses.

Results

A total of 192 HCC patients under the Milan criteria who underwent hepatic resection (n = 96), RFA (n = 23), or TACE (n = 73) were included. Higher LS ratings (kPa; hazard ratio [HR] = 1.12; 95% confidence interval [CI] = 1.01–1.25; p = 0.040) emerged as an independent risk factor for early tumor recurrence. In the subgroup analysis, higher LS ratings were associated with higher risks of early HCC recurrence in both the resection/RFA group (> 4.5 kPa; HR = 2.95; 95% CI = 1.26–6.94; p = 0.013) and the TACE group (> 6 kPa; HR = 2.94; 95% CI = 1.27–6.83; p = 0.012).

Conclusion

LS assessed by MRE was an independent predictor of early recurrence among HCC patients under the Milan criteria after achieving a complete response.

Key Points

• Liver parenchymal stiffness measured by MRE predicts early recurrence of treated HCC under Milan criteria.

• A liver stiffness > 5.5 kPa was associated with worse recurrence-free survival.

• Patients with high pre-treatment LS may benefit from stringent follow-up.

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Abbreviations

AASLD:

American Association for the Study of Liver Disease

AFP:

Alpha-fetoprotein

ALT:

Alanine transaminase

AST:

Aspartate aminotransferase

CI:

Confidence interval

CR:

Complete responses

CT:

Computed tomography

DM:

Diabetes mellitus

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

LS:

Liver stiffness

LT:

Liver transplantation

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

PIVKA-II:

Prothrombin induced by vitamin K absence or antagonist-II

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

ROC:

Receiving operating curve

ROIs:

Regions of interest

TACE:

Transarterial chemoembolization

UICC:

Union for International Cancer Control

US:

Ultrasonogram

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Funding

This work was supported by the Bio & Medical Technology Development Program of the NRF funded by the Korean government (MSIT) (NRF- 2018M3A9E8023861, NRF- 017R1D1A1B03033996, NRF- 2017R1D1A1B03029959) and the new faculty research fund of Ajou University School of Medicine.

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Correspondence to Jae Youn Cheong.

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The scientific guarantor of this publication is Jae Youn Cheong.

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The authors declare that they have no conflict of interest.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Cho, H.J., Kim, B., Kim, H.J. et al. Liver stiffness measured by MR elastography is a predictor of early HCC recurrence after treatment. Eur Radiol 30, 4182–4192 (2020). https://doi.org/10.1007/s00330-020-06792-y

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  • DOI: https://doi.org/10.1007/s00330-020-06792-y

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