Predicting the recurrence of hepatocellular carcinoma (≤ 5 cm) after resection surgery with promising risk factors: habitat fraction of tumor and its peritumoral micro-environment

• Published in: Radiologia medica Vol. 128; no. 10; pp. 1181 - 1191
• Main Authors: Zhang, Yunfei, Yang, Chun, Sheng, Ruofan, Dai, Yongming, Zeng, Mengsu
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.10.2023; Springer Nature B.V
• Subjects: Abdominal Radiology; Adult; Aged; Biomarkers; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Contrast Media; Decision analysis; Decision making; Diagnostic Radiology; Female; Habitats; Hepatectomy; Humans; Imaging; Interventional Radiology; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Magnetic Resonance Imaging - methods; Male; Mathematical analysis; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neuroradiology; Nomograms; Performance prediction; Predictive Value of Tests; Prognosis; Radiology; Regression analysis; Retrospective Studies; Risk Factors; Spatial distribution; Survival; Tumor Microenvironment; Ultrasound; Habitat imaging; Hepatocellular carcinoma; Recurrence-free survival; Peritumoral micro-environment
• DOI: 10.1007/s11547-023-01695-6
• ISSN: 1826-6983; 0033-8362

Purpose Characterizing the composition of hepatocellular carcinoma (HCC) and peritumoral micro-environment may provide sensitive biomarkers. We aimed to predict the recurrence-free survival (RFS) of HCC (≤ 5 cm) with habitat imaging of HCC and its peritumoral micro-environment. Material and Methods A total of 264 patients with HCC were included. Taking advantage of the enhancement ratio at the arterial and hepatobiliary phase of contrast-enhanced MRI, all HCCs and their peritumoral tissue of 3 mm and 4 mm were encoded with different habitats. Besides, the quantitative fraction of each habitat of HCC and peritumoral tissue were calculated. Univariable and multivariable Cox regression analysis was performed to select the prognostic factors. The nomogram-based predictor was established. Kaplan–Meier analysis was conducted to stratify the recurrence risk. Fivefold cross-validation was performed to determine the predictive performance with the concordance index (C-Index). Decision curve analysis was used to evaluate the net benefit. Results Qualitatively, the spatial distribution of the habitats varied for different survival outcomes. Quantitatively, the fraction of habitat 3 in peritumoral tissue of 4 mm (f 3 -P 4 ) was selected as independent risk factors (OR = 89.2, 95% CI = 14.5–549.2, p  < 0.001) together with other two clinical variables. Integrating both clinical variables and f 3 -P 4 , a nomogram was constructed and showed high predictive efficacy (C-Index: 0.735, 95% CI 0.617–0.854) and extra net benefit according to the decision curve. Furthermore, patients with low f 3 -P 4 or risk score given by nomogram have far longer RFS than those with high f 3 -P 4 or risk score (stratification by f 3 -P 4 : 131.9 vs 55.0 months and stratification by risk score:131.9 vs 34.1 months). Conclusion Habitat imaging of HCC and peritumoral microenvironment can be used for effectively and non-invasively estimating the RFS, which holds potential in guiding clinical management and decision making.