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. 2023 Nov:168:111120.
doi: 10.1016/j.ejrad.2023.111120. Epub 2023 Sep 29.

Prognostic value of baseline MRI features in patients treated with thermal ablation for hepatocellular carcinoma

Osman Öcal  1 , Kerstin Schütte  2 , Peter Malfertheiner  3 , Thomas Berg  4 , Christian Loewe  5 , Heinz Josef Klümpen  6 , Christoph Johannes Zech  7 , Otto van Delden  8 , Muzaffer Reha Ümütlü  1 , Sinan Deniz  1 , Najib Ben Khaled  3 , Enrico Narciso De Toni  3 , Thi Phuong Thao Hoang  1 , Ricarda Seidensticker  1 , Ali Aghdassi  9 , Maciej Pech  10 , Jens Ricke  1 , Max Seidensticker  11
Affiliations

Prognostic value of baseline MRI features in patients treated with thermal ablation for hepatocellular carcinoma

Osman Öcal et al. Eur J Radiol. 2023 Nov.

Abstract

Purpose: To investigate prognostic value of baseline MRI features for time-to-recurrence (TTR) and local recurrence in patients with early hepatocellular carcinoma (HCC).

Method: Baseline and follow-up images of 88 patients treated with thermal ablation followed by adjuvant sorafenib or matching placebo due to HCC within the phase II prospective randomized trial (SORAMIC) were included. Baseline MRI images were evaluated in terms of atypical enhancement (lack of wash-in or wash-out), lesion diameter, tumor capsule, peritumoral enhancement on arterial phase, intratumoral fat, irregular margin, satellite lesions, and peritumoral hypointensity on hepatobiliary phase. Prognostic value of these features for TTR and local recurrence were assessed with univariable and multivariable Cox proportional hazard models.

Results: Recurrence at any location was diagnosed during follow-up in 30 patients, and the median TTR was 16.4 (95% CI, 15 - NA) months. The presence of more than one lesion (p = 0.028) and peritumoral hypointensity on hepatobiliary phase images (p = 0.012) at baseline were significantly associated with shorter TTR in univariable analysis. AFP > 15 mg/dL (p = 0.084), and history of cirrhosis (p = 0.099) were marginally non-significant. Peritumoral hypointensity on hepatobiliary phase images was the only significant risk factor for recurrence in multivariable analysis (p = 0.003). Local recurrence (adjacent to thermal scar) was diagnosed in eleven (8.3%) out of 132 lesions that underwent thermal ablation. The only significant risk factor for local recurrence was a lesion diameter larger than 3 cm (22.2% vs. 4.5%, p = 0.007).

Conclusions: Peritumoral hypointensity on hepatobiliary phase can serve as imaging biomarker to identify increased recurrence risk in patients undergoing thermal ablation for early-stage HCC.

Keywords: Gadoxetic acid; Hepatocellular carcinoma; Local ablation; Peritumoral hypointensity; Time-to-recurrence.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Osman Öcal: Honoraria: Bayer. Kerstin Schütte: Honoraria & Advisory Board: Bayer. Thomas Berg: Grants: Abbvie, BMS, Gilead, MSD/Merck, Humedics, Intercept, Merz, Norgine, Novartis, Orphalan, Sequana Medical. Consulting fees: Abbvie, Alexion, Bayer, Gilead, GSK, Eisai, Enyo Pharma, HepaRegeniX GmbH, Humedics, Intercept, Ipsen, Janssen, MSD/Merck, Novartis, Orphalan, Roche, Sequana Medical, SIRTEX, SOBI, and Shionogi. Honoraria: Abbvie, Alexion, Bayer, Gilead, Eisai, Falk Foundation, Intercept, Ipsen, Janssen, MedUpdate GmbH, MSD/Merck, Novartis, Orphalan, Sequana Medica, SIRTEX, and SOBI. Travel fees: Gilead, Abbvie, Intercept, Janssen. Heinz Josef Klümpen: Honoraria: MEDtalks, IPSEN. Advisory Board: Astra Zeneca, Janssen, MSD, IPSEN. Najib Ben Khaled: Travel fees: EISAI. Honoraria: Falk. Enrico De Toni: Consultant: AstraZeneca, Bayer, BMS, EISAI, Eli Lilly & Co, Pfizer, IPSEN, and Roche. Travel fees: Arqule, AstraZeneca, BMS, Bayer, Celsion, and Roche. Honoraria: BMS, Falk. Grants: Arqule, AstraZeneca, BMS, Bayer, Eli Lilly, and Roche. Jens Ricke: Grants: Sirtex, Bayer; Personal fees: Sirtex, Bayer. Max Seidensticker: Personal fees: Bayer, Sirtex.