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Zhang K, He K, Zhang L, Li WC, Xie SS, Cui YZ, Lin LY, Shen ZW, Xia S, Su XM, Zhang HM, Ye ZX, Shen W. Gadoxetic Acid-enhanced MRI Scoring Model to Predict Pathologic Features of Hepatocellular Carcinoma. Radiology 2025; 314:e233229. [PMID: 39932410 DOI: 10.1148/radiol.233229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025]
Abstract
Background Prediction of high-risk pathologic features such as microvascular invasion (MVI), poorly differentiated pathologic grade (poor PG), and satellite nodules (SNs) has significant clinical value, as these features are associated with early recurrence and metastasis in hepatocellular carcinoma (HCC). Purpose To develop and validate a preoperative scoring model using gadoxetic acid-enhanced MRI features for noninvasive prediction of HCC high-risk pathologic features and early recurrence. Materials and Methods This retrospective study included consecutive patients with HCC who underwent preoperative gadoxetic acid-enhanced MRI at three centers (one training dataset and two external validation datasets) between January 2014 and January 2021. The preoperative imaging characteristics of each patient were evaluated via multivariable logistic regression, using surgical specimen pathologic evaluation as the reference standard, for prediction of MVI, poor PG, and SNs. In the training dataset, eight intratumoral features, three peritumoral features, and three laboratory indicators were initially evaluated. A scoring model was developed based on the results of the logistic regression, with the following imaging features demonstrating significant independent association with high-risk pathologic features: diameter greater than 4.0 cm, irregular morphology, intratumoral arteries, peritumoral enhancement in the arterial phase, and low peritumoral signal intensity. The resulting score, called the Image score (I-score), to predict early recurrence of HCC in patients was further validated in an outcome dataset. Results A total of 366 patients (median age, 57 years [IQR, 49-64 years]; 314 men, 52 women) from the three centers were included in the training dataset (n = 150), two external validation datasets (n = 73 and 56), and outcome dataset (n = 87). The area under the receiver operating characteristic curve (AUC) of the I-score for predicting high-risk pathologic features was 0.93 (95% CI: 0.88, 0.97) in the training dataset and 0.86 (95% CI: 0.76, 0.93) and 0.84 (95% CI: 0.72, 0.92) in the two external datasets. In the outcome dataset, the I-score was an independent predictor of early recurrence (hazard ratio, 5.2 [95% CI: 1.9, 14.2]; P = .002). A combined model including the I-score and two other predictors demonstrated superior prognostic performance (C index, 0.84 [95% CI: 0.74, 0.91]). Conclusion The developed scoring model based on gadoxetic acid-enhanced MRI enabled noninvasive preoperative prediction of HCC high-risk pathologic features and early recurrence. © RSNA, 2025 Supplemental material is available for this article.
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Affiliation(s)
- Kun Zhang
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Kan He
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Lei Zhang
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Wen-Cui Li
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Shuang-Shuang Xie
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Ying-Zhu Cui
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Li-Ying Lin
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Zhi-Wei Shen
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Shuang Xia
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Xiao-Min Su
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Hui-Mao Zhang
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Zhao-Xiang Ye
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
| | - Wen Shen
- From the Department of Radiology, Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai University, 24 Fukang Rd, Nankai District, Tianjin 300192, China (K.Z., S.S.X., L.Y.L., S.X., W.S.); Department of Radiology, First Hospital of Jilin University, Changchun, China (K.H., L.Z., Y.Z.C., H.M.Z.); Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Tianjin Key Laboratory of Digestive Cancer, Tianjin, China (W.C.L., Z.X.Y.); State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China (W.C.L., Z.X.Y.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (W.C.L., Z.X.Y.); Philips Healthcare, Beijing, China (Z.W.S.); and Department of Immunology, Nankai University School of Medicine, Nankai University, Tianjin, China (X.M.S.)
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Xu Y, Li Z, Zhou Y, Yang Y, Ouyang J, Li L, Huang Z, Ye F, Ying J, Zhao H, Zhou J, Zhao X. Using immunovascular characteristics to predict very early recurrence and prognosis of resectable intrahepatic cholangiocarcinoma. BMC Cancer 2023; 23:1009. [PMID: 37858111 PMCID: PMC10588260 DOI: 10.1186/s12885-023-11476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To predict the very early recurrence (VER) of patients with intrahepatic cholangiocarcinoma (ICC) based on TLSs and MVI status, and further perform prognosis stratifications. METHODS A total of 160, 51 ICC patients from two institutions between May 2012 and July 2022 were retrospectively included as training, external validation cohort. Clinical, radiological and pathological variables were evaluated and collected. Univariate and multivariate analysis were applied to select the significant factors related to VER of ICC. The factors selected were combined to perform stratification of overall survival (OS) using the Kaplan-Meier method with the log-rank test. RESULTS Overall, 39 patients (24.4%) had VER, whereas 121 (75.6%) did not (non-VER group). In the training cohort, the median OS was 40.5 months (95% CIs: 33.2-47.7 months). The VER group showed significantly worse OS than the non-VER group (median OS: 14.8, 95% CI:11.6-18.0 months vs. 53.4, 34.3-72.6 months; p<0.001), and it was confirmed in the validation cohort (median OS: 22.1, 95% CI: 8.8-35.4 months vs. 40.1, 21.2-59.0 months; p = 0.003). According to the univariate analysis, four variables were significantly different between the VER group and non-VER group (TLSs status, p = 0.028; differentiation, p = 0.023; MVI status, p = 0.012; diameter, p = 0.028). According to the multivariate analysis, MVI-positive status was independently associated with a higher probability of VER (odds ratio [OR], 2.5; 95% CIs,1.16-5.18; p = 0.018), whereas intra-tumoral TLSs-positive status was associated with lower odds of VER (OR, 0.43; 95% CIs, 0.19-0.97; p = 0.041). Based on the TLSs and MVI status, patients of ICC were categorized into four groups: TLSs-positive and MVI-negative (TP/MN); TLSs-negative and MVI-negative (TN/MN); TLSs-positive and MVI-positive (TP/MP), TLSs-negative and MVI-positive groups (TN/MP). In the training cohort, the four groups could be correlated with OS significantly (p<0.001), and it was confirmed in the validation cohort (p<0.001). CONCLUSION Intra-tumoral TLSs and MVI status are independent predictive factors of VER after surgery, based on which immunovascular stratifications are constructed and associated with OS significantly of resectable intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Ying Xu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuo Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Yi Yang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Lu Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianming Ying
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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