Highlights
- •The occurrence of peritumoral edema is more progressive and prone to recurrence.
- •Peritumoral edema is an prognostic factor for hepatocellular carcinoma.
- •Magnetic resonance imaging can better observation of peritumoral edema.
- •Can provide prognostic value for patients with hepatocellular carcinoma.
Abstract
Background
Peritumoral edema is an independent prognostic risk factor for malignant tumors. Therefore,
assessment of peritumoral edema in preoperative magnetic resonance imaging (MRI) may
provide better prognostic information in patients with hepatocellular carcinoma (HCC).
Aim
To determine whether peritumoral edema in preoperative MRI is a prognostic factor
for HCC.
Methods
A retrospective analysis of 90 patients with HCC confirmed by surgical pathology was
performed. All patients' peritumoral edema in preoperative MRI was reviewed by two
radiologists. The association of disease recurrence with peritumoral edema and clinicopathological
features was assessed using the Cox proportional hazards model. Interobserver agreement
for evaluating peritumoral edema was determined using Cohen's κ coefficient.
Results
Recurrence and non-recurrence after an average 20.8 month follow-up was 25.6% (23/90)
and 74.4% (67/90), respectively. The ratio of peritumoral edema of 90 patients with
HCC in preoperative MRI was 35.6% (32/90). In univariate Cox regression analysis,
peritumoral edema [hazard ratio (HR) 11.08, P < 0.001], tumor diameter (HR 4.12, P = 0.001), microvascular invasion (HR 2.78, P = 0.020), gender (HR 0.29, P = 0.006), cirrhosis (HR 2.45, P = 0.049), ascites syndrome (HR 2.83, P = 0.022), aspartate aminotransferase(AST)/alanine aminotransferase(ALT) (HR 5.07,
P = 0.003) were indicators for HCC recurrence. In multivariate Cox regression analysis,
the tumor diameter (HR 2.53, P = 0.032) and peritumoral edema (HR 8.71, P < 0.001) were independent prognostic factors of HCC. The sensitivity, specificity,
positive predictive value and negative predictive value of peritumoral edema and tumor
diameter were 82.6%&60.9%, 80.6%&77.6%, 59.4%&48.3%, and 93.1%&85.3%, respectively.
Conclusion
Peritumoral edema in preoperative MRI may be considered as a biomarker of prognostic
information for patients with HCC.
Keywords
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References
- Update in global trends and aetiology of hepatocellular carcinoma.Contemp Oncol. 2018; 22: 141-150
- Liver cancer incidence and mortality in China: temporal trends and projections to 2030.Chin J Cancer Res. 2018; 30: 571-579https://doi.org/10.21147/j.issn.1000-9604.2018.06.01
- Global trends and predictions in hepatocellular carcinoma mortality.J Hepatol. 2017; 67: 302-309https://doi.org/10.1016/j.jhep.2017.03.011
- Risk factors and patterns of early recurrence after curative hepatectomy for hepatocellular carcinoma.Surg Oncol. 2016; 25: 24-29https://doi.org/10.1016/j.suronc.2015.12.002
- Predictors of extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma.Ann Surg Oncol. 2010; 17: 2740-2746https://doi.org/10.1245/s10434-010-1076-2
- Impact of margin status on long-term results of liver resection for hepatocellular carcinoma: single-center time-to-recurrence analysis.Updates Surg. 2019; https://doi.org/10.1007/s13304-019-00686-5
- Dynamic liver function is an independent predictor of recurrence-free survival after curative liver resection for HCC - a retrospective cohort study.Int J Surg. 2019; 71: 56-65https://doi.org/10.1016/j.ijsu.2019.08.033
- Peritumoral edema on MRI at initial diagnosis: an independent prognostic factor for glioblastoma?.Eur J Neurol. 2009; 16: 874-878https://doi.org/10.1111/j.1468-1331.2009.02613.x
- Peritumoral edema shown by MRI predicts poor clinical outcome in glioblastoma.World J Surg Oncol. 2015; 13: 97https://doi.org/10.1186/s12957-015-0496-7
- Quantitative histopathologic assessment of perfusion MRI as a marker of glioblastoma cell infiltration in and beyond the peritumoral edema region.J Magn Reson Imaging. 2019; 50: 529-540https://doi.org/10.1002/jmri.26580
- Quantitative MRI for analysis of peritumoral edema in malignant gliomas.PLoS One. 2017; 12e0177135https://doi.org/10.1371/journal.pone.0177135
- Invasive breast cancer: prognostic value of peritumoral edema identified at preoperative MR imaging.Radiology. 2018; 287: 68-75https://doi.org/10.1148/radiol.2017171157
- Primary liver tumors: diagnosis by MR imaging.Am J Roentgenol. 1989; 152: 63-72https://doi.org/10.2214/ajr.152.1.63
- Peritumoral edema/tumor volume ratio: a strong survival predictor for posterior fossa metastases.Neurosurgery. 2019; 85: 117-125https://doi.org/10.1093/neuros/nyy222
- Improving survival prediction of high-grade glioma via machine learning techniques based on MRI radiomic, genetic and clinical risk factors.Eur J Radiol. 2019; 120108609https://doi.org/10.1016/j.ejrad.2019.07.010
- WHO grade of intracranial meningiomas differs with respect to patient’s age, location, tumor size and peritumoral edema.J Neurooncol. 2019; 145: 277-286https://doi.org/10.1007/s11060-019-03293-x
- Expression of aquaporin 5 and the AQP5 polymorphism A(-1364)C in association with peritumoral brain edema in meningioma patients.J Neurooncol. 2013; 112: 297-305https://doi.org/10.1007/s11060-013-1064-z
- Pathogenesis of peri-tumoral edema in intracranial meningiomas.Neurosurg Rev. 2019; 42: 59-71https://doi.org/10.1007/s10143-017-0897-x
- Statistical analysis of multi-b factor diffusion weighted images can help distinguish between vasogenic and tumor-infiltrated edema.J Magn Reson Imaging. 2014; 40: 622-629https://doi.org/10.1002/jmri.24399
- Sensitivity and specificity of unilateral edema on T2w-TSE sequences in MR-Mammography considering 974 histologically verified lesions.Breast J. 2010; 16: 233-239https://doi.org/10.1111/j.1524-4741.2010.00915.x
- Brain tumor hypoxia: tumorigenesis, angiogenesis, imaging, pseudoprogression, and as a therapeutic target.J Neurooncol. 2009; 92: 317-335https://doi.org/10.1007/s11060-009-9827-2
- Prognostic value of peritumoral edema and angiogenesis in intracranial meningioma surgery.J BUON. 2013; 18: 430-436
- Plasmatic B-type natriuretic peptide and C-reactive protein in hyperacute stroke as markers of CT-evidence of brain edema.Int J Med Sci. 2008; 5: 18-23https://doi.org/10.7150/ijms.5.18
- Neurovascular matrix metalloproteinases and the blood-brain barrier.Curr Pharm Des. 2012; 18 (3645-8.10.2174/138161212802002742)
- The disturbed blood-brain barrier in human glioblastoma.Mol Aspects Med. 2012; 33: 579-589https://doi.org/10.1016/j.mam.2012.02.003
- Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma.Ann Surg. 2000; 232 ([-24.10.1097/00000658-200007000-00003]): 10
- Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma.Surgery. 2000; 127: 603-608https://doi.org/10.1067/msy.2000.105498
- Systematic review: the prognostic role of alpha-fetoprotein following liver transplantation for hepatocellular carcinoma.Aliment Pharmacol Ther. 2012; 35: 987-999https://doi.org/10.1111/j.1365-2036.2012.05060.x
- Integrated nomograms for preoperative prediction of microvascular invasion and lymph node metastasis risk in hepatocellular carcinoma patients.Ann Surg Oncol. 2019; https://doi.org/10.1245/s10434-019-08071-7
- A radiomics nomogram for preoperative prediction of microvascular invasion in hepatocellular carcinoma.Liver Cancer. 2019; 8: 373-86.10.1159/000494099
- Rule of changes in serum GGT levels and GGT/ALT and AST/ALT ratios in primary hepatic carcinoma patients with different AFP levels.Cancer Biomark. 2018; 21: 743-746https://doi.org/10.3233/CBM-170088
- Clinicopathological determinants of survival after hepatic resection of hepatocellular carcinoma in 97 patients—experience from an Australian hepatobiliary unit.J Gastrointest Surg. 2010; 14: 1370-1380https://doi.org/10.1007/s11605-010-1277-9
Article Info
Publication History
Published online: January 19, 2021
Accepted:
January 17,
2021
Received in revised form:
January 2,
2021
Received:
August 23,
2020
Identification
Copyright
© 2021 Published by Elsevier Inc.
