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Risk stratification of LI-RADS M and LI-RADS 4/5 combined hepatocellular cholangiocarcinoma: prognostic values of MR imaging features and clinicopathological factors

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the role of clinicopathological factors and MR imaging factors in risk stratification of combined hepatocellular cholangiocarcinoma (cHCC-CCA) patients who were classified as LR-M and LR-4/5.

Methods

We retrospectively identified consecutive patients who were confirmed as cHCC-CCA after surgical surgery in our institution from June 2015 to November 2020. Two radiologists evaluated the preoperative MR imaging features independently, and each lesion was assigned with a LI-RADS category. Preoperative clinical data were also collected. Multivariate Cox proportional hazards model was applied to separately identify the independent factors correlated with the recurrence of cHCC-CCAs in LR-M and LR-4/5. Risk stratifications were conducted separately in LR-M and LR-4/5. Recurrence-free survival (RFS) rates and overall survival (OS) rates were analyzed by using the Kaplan-Meier survival curves and log-rank test.

Results

A total of 131 patients with single primary lesion which met the 2019 WHO classification criteria were finally included. Corona enhancement, delayed central enhancement, and microvascular invasion (MVI) were identified as predictors of RFS in LR-M. Mosaic architecture, CA19-9, and MVI were independently associated with RFS in LR-4/5. Based on the number of these independent predictors, patients were stratified into favorable-outcome groups (LR-ML subgroup and LR-4/5L subgroup) and dismal-outcome groups (LR-MH subgroup and LR-4/5H subgroup). The corresponding median RFS for LR-ML, LR-MH, LR-5L, and LR-5H were 25.6 months, 8.2 months, 51.7 months, and 18.1 months.

Conclusion

Our study explored the prognostic values of imaging and clinicopathological factors for LR-M and LR-4/5 cHCC-CCA patients, and different survival outcomes were observed among four subgroups after conducting risk stratifications.

Key Points

• Corona enhancement, delayed central enhancement, and MVI were identified as predictors of RFS in cHCC-CCAs which were classified into LR-M. Mosaic architecture, CA19-9, and MVI were independently associated with RFS in cHCC-CCAs which were classified into LR-4/5.

• Based on the identified risk factors, LR-M and LR-4/5 cHCC-CCA patients could be stratified into two subgroups respectively, with significantly different RFS and OS.

• cHCC-CCA patients from LR-M did not always have worse RFS and OS than those from LR-4/5 in some cases.

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Abbreviations

AFP:

Alpha-fetoprotein

CA19-9:

Carbohydrate 19-9

cHCC-CCA:

Combined hepatocellular cholangiocarcinoma

LI-RADS/LR:

Liver Imaging Reporting and Data System

MR:

Magnetic resonance

MVI:

Microvascular invasion

OS:

Overall survival

RFS:

Recurrence-free survival

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Funding

This study has received funding by National Natural Science Foundation of China (grant number 91859107), National Natural Science Foundation of China (grant number 82171897), Shanghai Science and Technology Committee (grant number 19411965500), Clinical Research Project of Zhongshan Hospital, Fudan University (grant number 2018ZSLC22), Shanghai Municipal Key Clinical Specialty (grant number shslczdzk03202), Clinical Research Plan of SHDC (grant number SHDC2020CR1029B), and Clinical Research Project of Zhongshan Hospital, Fudan University (grant number 2020ZSLC61).

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Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, Xuhui District, Shanghai, 200032, China

    Yi Wang, Chang-Wu Zhou, Na Li, Chun Yang & Meng-Su Zeng

  2. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Gui-Qi Zhu

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  1. Yi Wang
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Correspondence to Chun Yang or Meng-Su Zeng.

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Guarantor

The scientific guarantor of this publication is Mengsu Zeng.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethics approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Wang X, Wang W, Ma X et al (2020) Combined hepatocellular-cholangiocarcinoma: which preoperative clinical data and conventional MRI characteristics have value for the prediction of microvascular invasion and clinical significance? European radiology 30:5337-5347

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• retrospective

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• performed at one institution

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Wang, Y., Zhu, GQ., Zhou, CW. et al. Risk stratification of LI-RADS M and LI-RADS 4/5 combined hepatocellular cholangiocarcinoma: prognostic values of MR imaging features and clinicopathological factors. Eur Radiol 32, 5166–5178 (2022). https://doi.org/10.1007/s00330-022-08691-w

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