Preoperative Prediction of Microvascular Invasion with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients...

Area of Science:

• Hepatobiliary surgery
• Oncology
• Diagnostic imaging

Background:

• Microvascular invasion (MVI) is a key prognostic factor for hepatocellular carcinoma (HCC) recurrence.
• Preoperative prediction of MVI is crucial for guiding surgical decisions in HCC management.
• Current methods for MVI assessment have limitations in clinical application.

Purpose of the Study:

• To identify preoperative predictive factors for MVI in HCC.
• To stratify HCC patients based on MVI risk.
• To evaluate the impact of hepatectomy extent on oncologic outcomes in different MVI risk groups.

Main Methods:

• Retrospective analysis of 408 patients with single HCC (≤5 cm) who underwent preoperative gadoxetic acid-enhanced MRI.
• Logistic regression analysis to identify independent predictive factors for MVI.
• Kaplan-Meier analysis to assess recurrence-free and overall survival based on MVI risk stratification and hepatectomy type.

Main Results:

• Elevated alpha-fetoprotein (≥25 ng/mL), PIVKA-II (≥40 mAU/mL), tumor size (≥3 cm), non-smooth margin, and arterial peritumoral enhancement were independent predictors of MVI.
• Recurrence-free and overall survival significantly decreased with increasing MVI risk (low, intermediate, high).
• In the high MVI risk group, major hepatectomy showed a significantly lower 5-year cumulative recurrence rate (26.6%) compared to minor hepatectomy (59.8%).

Conclusions:

• Preoperative tumor markers and MRI features effectively predict MVI risk and prognosis in HCC patients.
• HCC patients stratified into high MVI risk groups exhibit the poorest outcomes.
• Major hepatectomy can improve long-term survival for patients identified as high MVI risk.