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Liver Imaging-Reporting and Data System treatment response algorithm predicts postsurgical recurrence in locoregional therapy–treated hepatocellular carcinoma

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

In HCC, locoregional therapy (LRT) is performed as a bridging or downstaging treatment before curative surgery. The impact of the LI-RADS Treatment Response (LR-TR) algorithm on surgical outcomes remains unknown. We aimed to evaluate radiologic and clinical factors predicting recurrence-free survival (RFS) and overall survival (OS) after curative surgery for LRT-treated HCC.

Materials and methods

Consecutive HCC patients who underwent liver transplantation or curative resection after LRT from 2010 to 2016 and had baseline and follow-up post-LRT CT/MRI up to the point of surgery were included. The LR-TR category at the time of surgery and other features were assessed using Cox proportional hazard models. RFS was estimated and compared using the Kaplan-Meier method with log-rank tests.

Results

We evaluated 73 patients with 115 lesions. The LR-TR viable category at the time of surgery (hazard ratio [HR], 3.84; 95% confidence interval [CI]: 1.04, 14.16), preoperative AFP > 200 ng/mL (HR, 3.63; 95% CI: 1.63, 8.10), LRT sessions > 3 (HR, 4.99; 95% CI: 1.73, 14.38), and resection (HR, 3.35; 95% CI: 1.39, 8.09) independently predicted recurrence. The risk score categorized the patients into poor, intermediate, and favorable-risk groups with 1-year RFS rates of 35.0%, 78.3%, and 97.0%, respectively (p < 0.001). Outside Milan at the time of surgery (HR, 5.79; 95% CI: 1.94, 17.07) and recurrence within the first postoperative year (HR, 17.66; 95% CI: 6.42, 48.56) predicted death.

Conclusion

In LRT-treated HCC, non-LR-TR viable disease achieved within fewer LRT sessions and removed by liver transplantation recurred less.

Key Points

• The Liver Imaging Reporting and Data System treatment response (LR-TR) viable disease (hazard ratio [HR], 3.84; p = 0.043), preoperative serum AFP level > 200 ng/mL (HR, 3.63; p = 0.002), more than three locoregional treatment (LRT) sessions (HR, 4.99; p = 0.003), and resection compared to liver transplantation (HR, 3.35; p = 0.001) were the independent predictors for postsurgical recurrence in LRT-treated HCCs.

• A scoring system combining LR-TR categories and key clinical factors stratifies the patients into poor, intermediate, and favorable recurrence risk groups, with 1-year RFS rates of 35.0%, 78.3%, and 97.0%, respectively (p < 0.001).

• Outside Milan at the time of surgery (HR, 5.79; p = 0.001) and recurrence within the first postoperative year (HR, 17.66; p < 0.001) were associated with poor overall survival.

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Abbreviations

AFP:

Alpha-fetoprotein

CI:

Confidence interval

CR:

Complete response

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LRT:

Locoregional therapy

LR-TR:

Liver Imaging Reporting and Data System treatment response

LT:

Liver transplantation

OS:

Overall survival

RFS:

Recurrence-free survival

TACE:

Transarterial chemoembolization

β :

Regression coefficient

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul, 06591, Korea

    Seo Yeon Youn, Bohyun Kim, Dong Hwan Kim & Joon-Il Choi

  2. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Ho Joong Choi

  3. Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Pil Soo Sung

Authors
  1. Seo Yeon Youn
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  2. Bohyun Kim
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  3. Dong Hwan Kim
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  4. Ho Joong Choi
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  6. Joon-Il Choi
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Correspondence to Bohyun Kim.

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The scientific guarantor of this publication is Bohyun Kim.

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The authors declare no competing interests.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• Retrospective

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• Performed at one institution

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Youn, S.Y., Kim, B., Kim, D.H. et al. Liver Imaging-Reporting and Data System treatment response algorithm predicts postsurgical recurrence in locoregional therapy–treated hepatocellular carcinoma. Eur Radiol 32, 6270–6280 (2022). https://doi.org/10.1007/s00330-022-08720-8

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  • DOI: https://doi.org/10.1007/s00330-022-08720-8

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