Preoperative assessment of microvascular invasion risk using gadoxetate-enhanced MRI for predicting outcomes after liver transplantation for single hepatocellular carcinoma within the Milan criteria

• Published in: European radiology 2024-01, Vol.34 (1), p.498-508
• Main Authors: Cha, Dong Ik, Kang, Tae Wook, Jeong, Woo Kyoung, Kim, Jong Man, Choi, Gyu-Seong, Joh, Jae-Won, Yi, Nam-Joon, Ahn, Soo Hyun
• Format: Article
• Language: English
• Subjects: Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - surgery; Criteria; Diagnostic Radiology; Gadolinium DTPA; Health care facilities; Hepatobiliary-Pancreas; Hepatocellular carcinoma; Humans; Imaging; Internal Medicine; Interventional Radiology; Liver; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Liver Transplantation; Liver transplants; Magnetic Resonance Imaging; Male; Medical prognosis; Medicine; Medicine & Public Health; Microvasculature; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - pathology; Neuroradiology; Patients; Prediction models; Prognosis; Radiology; Rank tests; Regression analysis; Retrospective Studies; Risk groups; Survival; Transplantation; Tumors; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09936-y

Objective To compare therapeutic outcomes after liver transplantation (LT) between hepatocellular carcinomas (HCC) with low and high risk for microvascular invasion (MVI) within the Milan criteria evaluated preoperatively. Methods Eighty patients with a single HCC who underwent LT as the initial therapy between 2008 and 2017 were included from two tertiary referral medical centers in a HBV-predominant population. A preoperative MVI-risk model was used to identify low- and high-risk patients. Recurrence-free survival (RFS) after LT between the two risk groups was compared using Kaplan-Meier curves with the log-rank test. Prognostic factors for RFS were identified using a multivariable Cox hazard regression analysis. Results Eighty patients were included (mean age, 51.8 years +/− 7.5 [standard deviation], 65 men). Patients were divided into low-risk ( n = 64) and high-risk ( n = 16) groups for MVI. The RFS rates after LT were significantly lower in the MVI high-risk group compared to the low-risk group at 1 year (75.0% [95% CI: 56.5–99.5%] vs. 96.9% [92.7–100%], p = 0.048), 3 years (62.5% [42.8–91.4%] vs. 95.3% [90.3–100%], p = 0.008), and 5 years (62.5% [42.8–91.4%] vs. and 95.3% [90.3–100%], p = 0.008). In addition, multivariable analysis showed that MVI high risk was the only significant factor for poor RFS ( p = 0.016). Conclusion HCC patients with a high risk of MVI showed significantly lower RFS after LT than those without. This model could aid in selecting optimal candidates in addition to the Milan criteria when considering upfront LT for patients with HCC if alternative treatment options are available. Clinical relevance statement High risk for microvascular invasion (MVI) in hepatocellular carcinoma patients lowered recurrence-free survival after liver transplantation, despite meeting the Milan criteria. Identifying MVI risk could aid candidate selection for upfront liver transplantation, particularly if alternative treatments are available. Key Points • A predictive model-derived microvascular invasion (MVI) high- and low-risk groups had a significant difference in the incidence of MVI on pathology. • Recurrence-free survival after liver transplantation (LT) for single hepatocellular carcinoma (HCC) within the Milan criteria was significantly different between the MVI high- and low-risk groups. • The peak incidence of tumor recurrence was 20 months after liver transplantation, probably indicating that HCC with high risk for MVI had a high risk of