Combining MRI criterion and pathology-based microvascular invasion improves prognostic stratification in early HCC
Xinyuan Jia1, Junhan Pan2, Yanshu Wang1
1Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Background & Aims:
Microvascular invasion (MVI) is an established risk factor for postoperative recurrence in hepatocellular carcinoma (HCC), but its assessment relies on histopathologic examination which is subject to sampling errors. Therefore, we aimed to develop and externally validate an integrated MRI-pathology prognostic stratification tool (MRI-Pathology Criterion [MPC]), which combines histopathologic MVI and MRI features to predict the risk of early recurrence.
Methods:
A total of 1,207 consecutive patients (median age, 56.0 years; 993 men; 666 with cirrhosis) with single BCLC 0/A HCC who underwent curative-intent resection and preoperative contrast-enhanced MRI at 12 hospitals across China, France, and the USA were retrospectively included in the training (n = 656) or testing (Eastern, n = 373; Western, n = 178) datasets. Four peritumoral (e.g., portal venous phase [PVP] peritumoral hypoenhancement) and 15 other previously reported prognostic MRI features were evaluated by two radiologists. Using early recurrence-free survival (eRFS; recurrence within 2 years) as the endpoint, an MPC was developed in the training dataset by combining histopathologic MVI and independently prognostic peritumoral MRI feature(s).
Results:
In the training dataset, PVP peritumoral hypoenhancement (hazard ratio 1.83; p <0.001) and histopathologic MVI (hazard ratio 2.59; p <0.001) were independent predictors of eRFS. Accordingly, MPC was defined using three risk groups: high risk (MVI+ and PVP+), intermediate risk (MVI+ and PVP-), and low risk (MVI-). In both testing datasets, eRFS differed significantly across the three groups (eRFS rates for the high-, intermediate-, and low-risk groups [East or West]: 44.6% or 37.5%; 65.6% or 57.6%; 84.7% or 73.9%; all p <0.001). MPC remained predictive of eRFS after adjusting for known prognostic factors, including α-fetoprotein level, tumor size, and Edmondson-Steiner grade (p values <0.001 to 0.006).
Conclusions:
The MPC integrates a peritumoral MRI feature with histopathologic MVI to refine postoperative prognostic stratification in HCC and may guide more individualized postoperative management.
Impact And Implications:
Based on 1,207 patients who underwent curative-intent resection for a single BCLC 0/A HCC at 12 tertiary hospitals across China, France, and the USA, this study demonstrated that integrating portal venous phase (PVP) peritumoral hypoenhancement on preoperative MRI with histopathologic microvascular invasion (MVI) improves prediction of HCC recurrence, potentially mitigating the limitations of sampling variability associated with histopathologic assessment. Using these two variables, the integrated MRI-Pathology Criterion (MPC) may provide a robust framework for postoperative recurrence-risk stratification and may help inform surveillance and adjuvant treatment strategies (e.g. intensified surveillance and longer durations of adjuvant therapy for patients classified as high risk by MPC). These findings are relevant to clinicians, radiologists, and pathologists involved in HCC management. However, prospective interventional studies, ideally randomized controlled trials, are needed to determine whether MPC-guided management improves clinically meaningful outcomes before MPC can be adopted for treatment allocation.
