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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The scientific guarantor of this publication is Jae Youn Cheong.
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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