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Integrating baseline MR imaging biomarkers into BCLC and CLIP improves overall survival prediction of patients with hepatocellular carcinoma (HCC)

  • Hepatobiliary-Pancreas
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Abstract

Objectives

We aimed to evaluate the independent predictive role of baseline imaging biomarkers for overall survival (OS) and transplant-free survival (TFS) in patients with HCC and assess the incremental value of these biomarkers to current staging systems.

Methods

In this retrospective IRB approved study, the clinical, laboratory, and imaging parameters of 304 HCC patients were collected. Cox regression model was utilized to identify the potential predictors of survival. Recursive partitioning test was utilized to identify the optimal ADC cutoff for stratifying patients’ OS. Patients were stratified based on Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program (CLIP). Binary ADC value (above vs. below the cutoff) and tumor margin (well- vs. ill-defined) were integrated into BCLC and CLIP. OS and TFS was compared for patients based on standard criteria with and without imaging biomarkers.

Results

At baseline, patients with low tumor ADC and well-defined tumor margin (favorable imaging biomarkers) had longer survival, as compared to those with high ADC and ill-defined tumor margin (unfavorable imaging biomarkers) (median OS of 43 months vs. 7 months, respectively) (p < 0.001). Tumor ADC and tumor margin remained strong independent predictors of survival after adjustment for demographics, BCLC and CLIP staging, and tumor burden. Incorporating ADC and tumor margin improved performance of OS prediction by 9% in BCLC group and 6% in CLIP group.

Conclusion

Incorporating ADC and tumor margin to current staging systems for HCC significantly improve prediction of OS and TFS of these criteria.

Key Points

• ADC and tumor margin are predictors of overall survival in HCC patients, independent of clinical, laboratory, and other imaging variables.

• Adding ADC and tumor margin improved the prognostic value of BCLC and CLIP criteria by 9% and 6%, respectively.

• High ADC and ill-defined tumor margin at baseline predicted poor survival, regardless of patient’s liver function and general health status.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

CT:

Computerized tomography

ADC:

Apparent diffusion coefficient

BCLC:

Barcelona Clinic Liver Cancer

CLIP:

Cancer of the Liver Italian Program

DWI:

Diffusion-weighted imaging

EASL:

European Association for the Study of the Liver

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

MVI:

Microscopic vascular invasion

OS:

Overall survival

PVI:

Portal venous invasion

TFS:

Transplant-free survival

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

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/MRI 143, Baltimore, MD, 21287, USA

    Mounes Aliyari Ghasabeh, Mohammadreza Shaghaghi, Ankur Pandey, Sanaz Ameli, Bharath Ambale Venkatesh, Angela Jacob, Pallavi Pandey, Bita Hazhirkarzar, Yan Luo, Roya Rezvani Habibabadi, Pegah Khoshpouri, Maryam Ghadimi & Ihab R. Kamel

  2. Department of Radiology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, China

    Yan Luo

Authors
  1. Mounes Aliyari Ghasabeh
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  2. Mohammadreza Shaghaghi
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Correspondence to Ihab R. Kamel.

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The scientific guarantor of this publication is Dr. Ihab R. Kamel.

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There authors declare no conflict of interest.

Statistics and biometry

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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• retrospective

• cross-sectional study

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This work originated in: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe St, Baltimore, MD 21287

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Aliyari Ghasabeh, M., Shaghaghi, M., Pandey, A. et al. Integrating baseline MR imaging biomarkers into BCLC and CLIP improves overall survival prediction of patients with hepatocellular carcinoma (HCC). Eur Radiol 31, 1630–1641 (2021). https://doi.org/10.1007/s00330-020-07251-4

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  • DOI: https://doi.org/10.1007/s00330-020-07251-4

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