Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6467-6473
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6467
Validated preoperative computed tomography risk estimation for postoperative hepatocellular carcinoma recurrence
Wei Zhang, Shao-Lv Lai, Jie Chen, Dong Xie, Fei-Xiang Wu, Guan-Qiao Jin, Dan-Ke Su
Wei Zhang, Shao-Lv Lai, Dong Xie, Guan-Qiao Jin, Dan-Ke Su, Departments of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jie Chen, Fei-Xiang Wu, Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Zhang W, Lai SL, Chen J and Xie D contributed equally to this work; Su DK designed the research; Zhang W wrote the manuscript; Zhang W, Lai SL, Chen J and Xie D collected the data; Wu FX and Jin GQ recorded the data; Zhang W, Lai SL, Chen J and Xie D performed the research; Zhang W analyzed the data; Su DK modified the manuscript; All authors gave final approval of this submission.
Institutional review board statement: : The study was reviewed and approved by the Affiliated Tumor Hospital of Guangxi Medical University Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymized clinical data that were obtained after each patient agreed by written consent to undergo computed tomography and curative resection.
Conflict-of-interest statement: The authors declared that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Dan-Ke Su, Professor, Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. sudanke@gxmu.edu.cn
Telephone: +86-771-5316832 Fax: +86-771-5316832
Received: June 14, 2017
Peer-review started: June 15, 2017
First decision: July 17, 2017
Revised: July 26, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 21, 2017
Processing time: 98 Days and 14.8 Hours
Abstract
AIM

To develop and validate a risk estimation of tumor recurrence following curative resection of operable hepatocellular carcinoma (HCC).

METHODS

Data for 128 patients with operable HCC (according to Barcelona Clinic Liver Cancer imaging criteria) who underwent preoperative computed tomography (CT) evaluation at our hospital from May 1, 2013 through May 30, 2014 were included in this study. Follow-up data were obtained from hospital medical records. Follow-up data through May 30, 2016 were used to retrospectively analyze preoperative multiphasic CT findings, surgical histopathology results, and serum α-fetoprotein and thymidine kinase-1 levels. The χ2 test, independent t-test, and Mann-Whitney U test were used to analyze data. A P-value of < 0.05 was considered statistically significant.

RESULTS

During the follow-up period, 38 of 128 patients (29.7%) had a postoperative HCC recurrence. Microvascular invasion (MVI) was associated with HCC recurrence (χ2 = 13.253, P < 0.001). Despite postoperative antiviral therapy and chemotherapy, 22 of 44 patients with MVI experienced recurrence after surgical resection. The presence of MVI was 57.9% sensitive, 75.6% specific and 70.3% accurate in predicting postoperative recurrence. Of 84 tumors without MVI, univariate analysis confirmed that tumor margins, tumor margin grade, and tumor capsule detection on multiphasic CT were associated with HCC recurrence (P < 0.05). Univariate analyses showed no difference between groups with respect to hepatic capsular invasion, Ki-67 proliferation marker value, Edmondson-Steiner grade, largest tumor diameter, necrosis, arterial phase enhanced ratio, portovenous phase enhanced ratio, peritumoral enhancement, or serum α-fetoprotein level.

CONCLUSION

Non-smooth tumor margins, incomplete tumor capsules and missing tumor capsules correlated with postoperative HCC recurrence. HCC recurrence following curative resection may be predicted using CT.

Keywords: Hepatocellular carcinoma; Microvascular invasion; Computed tomography; Recurrence; Tumor margin; Tumor capsule

Core tip: We discuss risk estimation for recurrence following curative resection of operable hepatocellular carcinoma that meets Barcelona Clinic Liver Cancer imaging criteria. Preoperative multiphasic computed tomography findings, including non-smooth tumor margins, incomplete tumor capsule and missing tumor capsule, can predict hepatocellular carcinoma recurrence following curative resection. Treatment should include wide margins during curative resection, followed by antiviral therapy and chemotherapy.