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Subcentimeter hepatocellular carcinoma (HCC) on gadoxetic-acid-enhanced MRI: less frequent typical imaging features compared to 1–2 cm HCC but better prognosis after surgical resection

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the imaging features, pathologic characteristics, and survival outcomes between subcentimeter and 1–2 cm hepatocellular carcinoma (HCC).

Methods

This retrospective observational study evaluated the imaging features and medical records of patients with HCC smaller than 2 cm who underwent surgical resection with preoperative gadoxetic-acid-enhanced MRI (EOB-MRI) from January 2013 to December 2021. The incidence of EOB-MRI features and pathological characteristics between the subcentimeter and 1–2 cm HCC were compared. The recurrence-free survival (RFS), including early and overall tumor recurrence, and overall survival (OS) were assessed.

Results

A total of 223 patients (82 with subcentimeter HCC and 141 with 1–2 cm HCC, 179 men) were enrolled. Compared with 1–2 cm HCC, subcentimeter HCC showed fewer restricted diffusion (87.8 vs. 95.7%, P = 0.027), portal-phase washout (58.5% vs. 73.8%, P = 0.013), typical enhancement pattern (50.0% vs. 66.7%, P =0.014), and microvascular invasion (4.9% vs. 14.9%, P = 0.022). Patients with subcentimeter HCC had higher RFS (P = 0.027) and better OS (P = 0.029). The estimated RFS rates at 5 years was 83.3% for subcentimeter HCC and 67.3% for 1–2 cm HCC, respectively. The estimated OS rates at 5 years was 97.3% for subcentimeter HCC and 89.5% for 1–2 cm HCC, respectively.

Conclusion

Subcentimeter HCC showed less frequent EOB-MRI features seen typically in 1–2 cm HCC but better survival outcomes. Therefore, tailored early diagnostic criteria and immediate treatment for subcentimeter HCC may be warranted.

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Data availability

The data used and analyzed in this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Kulik L, El-Serag HB (2019) Epidemiology and Management of Hepatocellular Carcinoma. Gastroenterology 156:477-491 e471

    Google Scholar 

  2. Reig M, Forner A, Rimola J et al (2022) BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 76:681-693

    Article  PubMed  Google Scholar 

  3. Omata M, Cheng AL, Kokudo N et al (2017) Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 11:317-370

    Article  PubMed  Google Scholar 

  4. Kudo M, Kawamura Y, Hasegawa K et al (2021) Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update. Liver Cancer 10:181-223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Zhou J, Sun HC, Wang Z et al (2018) Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition). Liver Cancer 7:235-260

    Article  PubMed  PubMed Central  Google Scholar 

  6. Heimbach JK, Kulik LM, Finn RS et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67:358-380

    Article  PubMed  Google Scholar 

  7. Cerny M, Bergeron C, Billiard JS et al (2018) LI-RADS for MR Imaging Diagnosis of Hepatocellular Carcinoma: Performance of Major and Ancillary Features. Radiology 288:118-128

    Article  PubMed  Google Scholar 

  8. Choi JY, Lee JM, Sirlin CB (2014) CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 273:30-50

    Article  PubMed  Google Scholar 

  9. Lu XY, Xi T, Lau WY et al (2011) Pathobiological features of small hepatocellular carcinoma: correlation between tumor size and biological behavior. J Cancer Res Clin Oncol 137:567-575

    Article  PubMed  Google Scholar 

  10. Yu MH, Kim JH, Yoon JH et al (2014) Small (</=1-cm) hepatocellular carcinoma: diagnostic performance and imaging features at gadoxetic acid-enhanced MR imaging. Radiology 271:748-760

    Article  PubMed  Google Scholar 

  11. Woo JH, Song KD, Kim SH (2017) Subcentimeter hypervascular nodules with typical imaging findings of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: Outcomes of early treatment and watchful waiting. Eur Radiol 27:4406-4414

    Article  PubMed  Google Scholar 

  12. Sun X, Hu D, Zhang Y et al (2020) Can Immediately Treating Subcentimeter Hepatocellular Carcinoma Improve the Survival of Patients? J Hepatocell Carcinoma 7:377-384

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Huang P, Zhou C, Wu F et al (2023) An improved diagnostic algorithm for subcentimeter hepatocellular carcinoma on gadoxetic acid-enhanced MRI. Eur Radiol 33:2735–2745

    Article  CAS  PubMed  Google Scholar 

  14. Durnez A, Verslype C, Nevens F et al (2006) The clinicopathological and prognostic relevance of cytokeratin 7 and 19 expression in hepatocellular carcinoma. A possible progenitor cell origin. Histopathology 49:138-151

    Article  CAS  PubMed  Google Scholar 

  15. Wu H, Han X, Wang Z et al (2020) Prediction of the Ki-67 marker index in hepatocellular carcinoma based on CT radiomics features. Phys Med Biol 65:235048

    Article  CAS  PubMed  Google Scholar 

  16. Roayaie S, Blume IN, Thung SN et al (2009) A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma. Gastroenterology 137:850-855

    Article  PubMed  Google Scholar 

  17. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L (2018) EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 69:182-236

    Article  Google Scholar 

  18. Marrero JA, Kulik LM, Sirlin CB et al (2018) Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723-750

    Article  PubMed  Google Scholar 

  19. Park MJ, Kim YS, Lee WJ, Lim HK, Rhim H, Lee J (2010) Outcomes of follow-up CT for small (5-10-mm) arterially enhancing nodules in the liver and risk factors for developing hepatocellular carcinoma in a surveillance population. Eur Radiol 20:2397-2404

    Article  PubMed  Google Scholar 

  20. Choi MH, Choi JI, Lee YJ, Park MY, Rha SE, Lall C (2017) MRI of Small Hepatocellular Carcinoma: Typical Features Are Less Frequent Below a Size Cutoff of 1.5 cm. AJR Am J Roentgenol 208:544-551

    Article  PubMed  Google Scholar 

  21. Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y (2009) Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography--radiologic-pathologic correlation. Radiology 252:605-614

    Article  PubMed  Google Scholar 

  22. Kim DH, Choi SH, Kim SY, Kim MJ, Lee SS, Byun JH (2019) Gadoxetic Acid-enhanced MRI of Hepatocellular Carcinoma: Value of Washout in Transitional and Hepatobiliary Phases. Radiology 291:651-657

    Article  PubMed  Google Scholar 

  23. Shah SA, Cleary SP, Wei AC et al (2007) Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery 141:330-339

    Article  PubMed  Google Scholar 

  24. Yeh CN, Chen MF, Lee WC, Jeng LB (2002) Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis. J Surg Oncol 81:195-202

    Article  PubMed  Google Scholar 

  25. Wang H, Wu MC, Cong WM (2019) Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis. Hepatol Res 49:344-354

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported by the Clinical Research Plan of SHDC (No. SHDC2020CR1029B), National Natural Science Foundation of China (No. 82171897), National Natural Science Foundation of China (No. 82272078), Shanghai Municipal Health Commission (No. 202240152), and Shanghai Municipal Key Clinical Specialty (No. shslczdzk03202).

Author information

Author notes

  1. Peng Huang, Qin Shi, and Xiaoyan Ni shared co-first authorship.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Peng Huang, Xiaoyan Ni, Changwu Zhou, Fei Wu, Cheng Wang, Yuyao Xiao, Gengyun Miao, Chun Yang & Mengsu Zeng

  2. Shanghai Institute of Medical Imaging, Shanghai, China

    Qin Shi, Changwu Zhou & Mengsu Zeng

  3. Department of Cancer Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Peng Huang, Xiaoyan Ni, Changwu Zhou, Fei Wu, Cheng Wang, Yuyao Xiao, Gengyun Miao, Chun Yang & Mengsu Zeng

  4. Department of Radiology, People’s Hospital of Rizhao, Shandong, China

    Lincheng Liu

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  1. Peng Huang
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Corresponding authors

Correspondence to Chun Yang or Mengsu Zeng.

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Conflict of interest

All authors declare no conflict of interest in the study.

Ethical approval

The study protocol was complied with the principles of the Declaration of Helsinki and was approved by the institutional review board of the Zhongshan Hospital, Fudan University (No. B2020-372R).

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The ethics committee of Zhongshan Hospital, Fudan University agreed to the consent to participate.

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Huang, P., Shi, Q., Ni, X. et al. Subcentimeter hepatocellular carcinoma (HCC) on gadoxetic-acid-enhanced MRI: less frequent typical imaging features compared to 1–2 cm HCC but better prognosis after surgical resection. Abdom Radiol 48, 3391–3400 (2023). https://doi.org/10.1007/s00261-023-04024-7

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  • DOI: https://doi.org/10.1007/s00261-023-04024-7

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