Purpose: To investigate the applicability of MRI-based preoperative risk markers in assisting clinicians to define an appropriate surgical margin width for patients with solitary hepatocellular carcinoma.
Methods: Patients who underwent preoperative MRI with hepatectomy were randomly divided into development (65%) and internal validation (35%) datasets between January 2015 and January 2019. Multivariate logistic analysis was used to evaluate MRI-based markers of early recurrence (≤2 years) in the development dataset. Independent factors in the development dataset were investigated using a multivariable Cox analysis. The multivariable logistic and Cox models were verified using the risk score system in the validation dataset. Recurrence-free survival (RFS) was calculated according to MRI-based preoperative markers together with a narrow or wide margin in all datasets.
Results: A narrow resection margin was identified as an independent risk factor for early postoperative recurrence (P < 0.001) according to multivariable Cox analysis. RFS was significantly shorter in patients with narrow resection margins than that of those with wide resection margins (P < 0.005). Patients with the three MRI-based preoperative markers (tumour size > 5 cm, substantial necrosis, and non-smooth margins) combined with a narrow resection margin had a shorter RFS than that of those with a wide margin (P < 0.005). Patients without these markers also benefitted from a wide margin (P < 0.05).
Conclusions: MRI-based preoperative risk markers in combination with narrow resection margins were associated with a higher recurrence rate compared with wide resection margins, and hence, such patients may benefit from a wide-margin hepatectomy.
Keywords: Early recurrence; Hepatocellular carcinoma; MRI; Surgical margin.
Copyright © 2022. Published by Elsevier B.V.