Hepatic imaging characteristics predict overall survival in hepatocellular carcinoma

Pathologic tumor-related factors, including vascular invasion, remain the only reliable predictor of recurrence and overall survival in hepatocellular cancer (HCC). Other preoperative factors, such as hepatitis status, degree of liver disease (cirrhosis), number of tumors, and size of tumors have been inconsistent in predicting outcome. The aim of this study is to demonstrate that standard radiological imaging characteristics will predict overall survival in HCC.

We identified 103 HCC treated in our department from January 1999 to June 2005. All images were reviewed by two blinded physicians and classified into one of three radiological characteristics: pusher/mass forming (well encapsulated without parenchymal violation), invader (non-encapsulated with violation of parenchyma), and hanger/pedunculated (encapsulated with a majority of the lesion suspended from segments II, III, IV b, V, and / or VI).

The study included 61 males and 31 females with a median age of 61 years (range 23 to 90 years), a median of one lesion (range 1-10), a majority with <25% liver involvement, with a median lesion size of 6 cm (range 1 to 22 cm). Surgical therapy included hepatic resection 34 (33%), RFA 23 (22%), and liver transplantation 21 (20%). The distribution of radiological characteristics at initial evaluation was 54% pushers, 41% invaders, and 4% hangers. Median survival for invaders (8.2 months) and hangers (10.0 months) was significantly lower than for pushers (median 29 months) (p = 0.0007).

Standard, reproducible radiological characteristics are predictive of outcome in patients with HCC. Greater emphasis on identifying preoperative factors remains imperative to better identify patients' biology and determine which should undergo resection or transplantation.