Peritumoral edema in preoperative magnetic resonance imaging is an independent prognostic factor for hepatocellular carcinoma

Hai-Lu He; Qiang Wang; Lu Liu; Ning-Bin Luo; Dan-Ke Su; Guan-Qiao Jin

doi:10.1016/j.clinimag.2021.01.022

Peritumoral edema in preoperative magnetic resonance imaging is an independent prognostic factor for hepatocellular carcinoma

Clin Imaging. 2021 Jul:75:143-149. doi: 10.1016/j.clinimag.2021.01.022. Epub 2021 Jan 20.

Authors

Hai-Lu He¹, Qiang Wang², Lu Liu³, Ning-Bin Luo⁴, Dan-Ke Su⁵, Guan-Qiao Jin⁶

Affiliations

¹ Department of Radiology, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Electronic address: hehailu2019@163.com.
² Department of Anesthesia, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Electronic address: 314316005@qq.com.
³ Department of Radiology, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Electronic address: liulu33@stu.gxmu.edu.cn.
⁴ Department of Radiology, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Electronic address: luoningbin2012@hotmail.com.
⁵ Department of Radiology, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Electronic address: sudanke@gxmu.edu.cn.
⁶ Department of Radiology, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. Electronic address: jinguanqiao77@gxmu.edu.cn.

PMID: 33556644
DOI: 10.1016/j.clinimag.2021.01.022

Abstract

Background: Peritumoral edema is an independent prognostic risk factor for malignant tumors. Therefore, assessment of peritumoral edema in preoperative magnetic resonance imaging (MRI) may provide better prognostic information in patients with hepatocellular carcinoma (HCC).

Aim: To determine whether peritumoral edema in preoperative MRI is a prognostic factor for HCC.

Methods: A retrospective analysis of 90 patients with HCC confirmed by surgical pathology was performed. All patients' peritumoral edema in preoperative MRI was reviewed by two radiologists. The association of disease recurrence with peritumoral edema and clinicopathological features was assessed using the Cox proportional hazards model. Interobserver agreement for evaluating peritumoral edema was determined using Cohen's κ coefficient.

Results: Recurrence and non-recurrence after an average 20.8 month follow-up was 25.6% (23/90) and 74.4% (67/90), respectively. The ratio of peritumoral edema of 90 patients with HCC in preoperative MRI was 35.6% (32/90). In univariate Cox regression analysis, peritumoral edema [hazard ratio (HR) 11.08, P < 0.001], tumor diameter (HR 4.12, P = 0.001), microvascular invasion (HR 2.78, P = 0.020), gender (HR 0.29, P = 0.006), cirrhosis (HR 2.45, P = 0.049), ascites syndrome (HR 2.83, P = 0.022), aspartate aminotransferase(AST)/alanine aminotransferase(ALT) (HR 5.07, P = 0.003) were indicators for HCC recurrence. In multivariate Cox regression analysis, the tumor diameter (HR 2.53, P = 0.032) and peritumoral edema (HR 8.71, P < 0.001) were independent prognostic factors of HCC. The sensitivity, specificity, positive predictive value and negative predictive value of peritumoral edema and tumor diameter were 82.6%&60.9%, 80.6%&77.6%, 59.4%&48.3%, and 93.1%&85.3%, respectively.

Conclusion: Peritumoral edema in preoperative MRI may be considered as a biomarker of prognostic information for patients with HCC.

Keywords: Hepatocellular carcinoma; Magnetic resonance imaging; Peritumoral edema; Prognosis.

MeSH terms

Carcinoma, Hepatocellular* / diagnostic imaging
Carcinoma, Hepatocellular* / surgery
Edema / diagnostic imaging
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / surgery
Magnetic Resonance Imaging
Neoplasm Recurrence, Local / diagnostic imaging
Prognosis
Retrospective Studies