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Liver Imaging Reporting and Data System Category on Magnetic Resonance Imaging Predicts Recurrence of Hepatocellular Carcinoma After Liver Transplantation Within the Milan Criteria: A Multicenter Study

  • Hepatobiliary Tumors
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Abstract

Background

This study was designed to investigate the association between Liver Imaging Reporting and Data System (LI-RADS) category and recurrence of hepatocellular carcinoma (HCC) after primary liver transplantation (LT) within the Milan criteria.

Methods

This multicenter, retrospective study included 140 recipients who underwent living donor LT (LDLT) for treatment-naïve HCC and pretransplant contrast-enhanced magnetic resonance imaging (MRI) between 2009 and 2013. LI-RADS categories were assigned using LI-RADS version 2018. Recurrence-free survival (RFS) and associated factors were evaluated using Cox proportional hazards regression analysis, Kaplan-Meier analysis, and log-rank test. Histological grading and microvascular invasion (MVI) were analyzed on the pathologic examinations of explanted livers.

Results

The overall 1-, 3-, 5-, and 7-year RFS rates were 95.6%, 92.6%, 90.2%, and 89.3%, respectively. In the multivariable analysis, independent predictors of recurrence included HCCs categorized as LR-M (hazard ratio [HR], 18.68; 95% confidence interval [CI], 5.79–60.23; P < 0.001) and the largest tumor size of ≥ 3 cm on MRI (HR, 4.18; 95% CI, 1.42–12.37; P = 0.010). The 5-year RFS rate was significantly lower in patients with HCCs categorized as LR-M than in those with HCCs categorized as LR-5 or 4 (LR-5/4) (36.9% vs. 95.8%, respectively; P < 0.001). HCCs categorized as LR-M exhibited significantly more MVI than HCCs categorized as LR-5/4 (57.1% vs. 17.5%, respectively; P = 0.002).

Conclusions

Patients with HCCs categorized as LR-M using LI-RADS version 2018 may have a worse prognosis after primary LT within the Milan criteria than those with HCCs categorized as LR-5/4.

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Acknowledgments

This study was supported by a young researcher grant from the Korea Society for Transplantation and the Basic Science Research Program through the National Research Foundation (NRF) of Korea, funded by the Ministry of Science, ICT, and Future Planning (No. 2017R1E1A1A03070961). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Sunyoung Lee MD, PhD

  2. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Kyoung Won Kim MD, PhD & So Yeong Jeong MD

  3. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Woo Kyoung Jeong MD, PhD & Jeong Ah Hwang MD, PhD

  4. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jin Sub Choi MD, PhD

  5. Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Sung-Gyu Lee MD, PhD

  6. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jae-Won Joh MD, PhD

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  1. Sunyoung Lee MD, PhD
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  2. Kyoung Won Kim MD, PhD
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  3. Woo Kyoung Jeong MD, PhD
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  4. So Yeong Jeong MD
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  5. Jeong Ah Hwang MD, PhD
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  6. Jin Sub Choi MD, PhD
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  7. Sung-Gyu Lee MD, PhD
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Correspondence to Kyoung Won Kim MD, PhD.

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Lee, S., Kim, K.W., Jeong, W.K. et al. Liver Imaging Reporting and Data System Category on Magnetic Resonance Imaging Predicts Recurrence of Hepatocellular Carcinoma After Liver Transplantation Within the Milan Criteria: A Multicenter Study. Ann Surg Oncol 28, 6782–6789 (2021). https://doi.org/10.1245/s10434-021-09772-8

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  • DOI: https://doi.org/10.1245/s10434-021-09772-8

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