Predicting post-resection recurrence by integrating imaging-based surrogates of distinct vascular patterns of hepatocellular carcinoma

Abstract

Background & AimsThe distinct vascular patterns, including microvascular invasion (MVI) and vessels encapsulating tumor clusters (VETC), are associated with poor outcome of hepatocellular carcinoma (HCC). Imaging surrogates of these vascular patterns potentially helped predict postresection recurrence. Herein, a prognostic model integrating imaging-based surrogates of these distinct vascular patterns was developed for predicting postoperative recurrence-free survival (RFS) in HCC.MethodsClinic-radiologic data of 1,285 HCC patients from China undergoing surgical resection were retrospectively enrolled from seven medical centers between 2014 and 2020. A prognostic model using clinical data and imaging-based surrogates of MVI and VETC patterns was developed (n = 297) and externally validated (n = 373) for predicting RFS. The surrogates (i.e., MVI and VETC scores) were individually built from preoperative computed tomography using two independent sets (n = 360 and 255). Whether the model's stratification was associated with postoperative recurrence following anatomic resection was also evaluated.ResultsThe MVI and VETC scores demonstrated effective performance in their respective training and validation cohorts (area under the curve: 0.851–0.883 for MVI and 0.834–0.844 for VETC). The prognostic model incorporating serum alpha-fetoprotein, tumor multiplicity, MVI score, and VETC score achieved a C-index of 0.748–0.764 for developing and external validation and generated three prognostically distinct strata. For patients at model-predicted medium risk, anatomic resection was associated with improved RFS (p < 0.05). By contrast, anatomic resection had no impact on RFS in patients at model-predicted low or high risk (both p > 0.05).ConclusionsThe proposed model integrating imaging-based surrogates of distinct vascular patterns enabled accurate prediction for RFS. It can potentially be used to identify HCC surgical candidates who may benefit from anatomic resection.Impact and implicationsMicrovascular invasion (MVI) and vessels encapsulating tumor clusters (VETC) are distinct vascular patterns of hepatocellular carcinoma (HCC) associated with aggressive biological behavior and poor outcomes. Our multicenter study provided a model incorporating the imaging-based surrogates of these patterns for preoperatively predicting recurrence-free survival. The proposed model, providing imaging detection of the risk of MVI and VETC, offers an opportunity to help brighten light on the association of tumor aggressiveness and prognosis and support the selection of the type of surgical resection.

Topics & Concepts