LI-RADS Category Can Be a Post-Surgical Prognostic Factor for Intrahepatic Cholangiocarcinoma in Patients with Liver Cirrhosis or Chronic Hepatitis B

Abstract

Introduction: The Liver Imaging Reporting and Data System (LI-RADS) categorization has been proposed as a potential prognostic indicator for primary liver neoplasms in patients with liver cirrhosis or chronic hepatitis B. This multicenter study aimed to determine whether LI-RADS categorization can offer additional post-surgical prognostic value for intrahepatic cholangiocarcinoma (ICCA) when used in conjunction with the American Joint Committee on Cancer (AJCC) guidelines.

Methods: Patients with high risk for hepatocellular carcinoma, surgically confirmed ICCAs, and available preoperative MRI were enrolled. LI-RADS categorization of ICCAs was performed using MRI features, and multivariate analyses were conducted incorporating LI-RADS category, AJCC staging, and clinicopathologic factors to evaluate their predictive value for postoperative recurrence-free survival (RFS) and overall survival (OS). In patients with early recurrence (<2 years), the percentages of AJCC stage I and LR-M or LR tumor-in-vein (TIV) were calculated, respectively.

Results: Among the 166 ICCAs analyzed, 13.3% (22/166) were classified as LR-4/5, 77.7% (129/166) as LR-M, and 9.0% (15/166) as LR TIV. Classifications according to the 8th AJCC guidelines for patients with available post-surgical pathologic data and follow-up imaging were 40.6% (63/155) stage I tumors, 23.9% (37/155) stage II, and 35.5% (55/155) stage III. Multivariate analysis revealed that LI-RADS category (LR-M or LR-TIV) was a significant factor for predicting both RFS (hazard ratio [HR] = 2.86, p = 0.02) and OS (HR = 3.18, p = 0.03). Additionally, AJCC staging (II or III) was a significant factor for RFS (HR = 3.90, p < 0.001) and OS (HR = 3.29, p < 0.001), male sex was a significant factor for RFS (HR = 1.89, p = 0.006) and OS (HR = 2.23, p = 0.002), and positive resection margin was a significant factor for OS (HR = 1.91, p = 0.03). Among the 80 patients with early recurrence, 97.5% displayed LR-M or LR-TIV features, while 11.3% were AJCC stage I patients.

Conclusion: The MRI-based preoperative LI-RADS categorization of ICCA provides additional post-surgical prognostic value beyond the AJCC guidelines, with significant implications for both RFS and OS.

Keywords: Cholangiocarcinoma; Liver Imaging Reporting and Data System; Magnetic resonance imaging; Recurrence; Survival.

Fig. 1.

Flow diagram of patient enrollment.

Fig. 2.

Mass-forming intrahepatic cholangiocarcinoma in a 59-year-old man with chronic hepatitis B virus infection. a–c Gadoxetic acid-enhanced MRI shows a 4.5 cm rim arterial phase hyperenhancing mass (a, arrow) in segment IV with delayed central enhancement and peripheral washout (b, arrow). It also shows a targetoid hepatobiliary phase appearance (c, arrow). The lesion was TNM stage I (T1a, N0, M0), according to the AJCC 8th edition, whereas it was categorized into LI-RADS category M on gadoxetic acid-enhanced MRI. At 19 months after hepatic resection, the tumor recurred as lymph node metastases (d, arrows). This patient died 47 months after surgery.

Fig. 3.

Mass-forming intrahepatic cholangiocarcinoma in a 60-year-old man with chronic hepatitis B virus infection. a–c Gadoxetic acid-enhanced MRI shows a 1.9 cm non-rim arterial phase hyperenhancing mass (a, arrow) in segment VI with arterial corona enhancement and non-peripheral portal washout (b, arrow). It also shows a non-infiltrative appearance (c, arrow). The lesion was TNM stage I (T1a, N0, M0), according to the AJCC 8th edition, and was categorized into LI-RADS category 5 on gadoxetic acid-enhanced MRI. The tumor did not recur, and the patient survived for 55 months following the hepatic wedge resection (d, contrast-enhanced CT at 55 months after surgery).

Fig. 4.

Kaplan-Meier analyses of RFS and OS according to AJCC stage (a, b) and LI-RADS category (c, d).