A new diagnostic scoring method incorporating the arterial phase excess enhancement (APHE) ratio on magnetic resonance imaging (MRI) may help improve recurrence risk assessment in patients undergoing treatment for hepatocellular carcinoma.
For this retrospective study, recently published in RadiologyThe researchers evaluated the model by reviewing clinical and imaging data from 430 patients with early- to intermediate-stage HCC who underwent preoperative contrast-enhanced MRI and therapeutic resection.
The study authors calculated late postoperative recurrence based on the sum of the patient’s serum neutrophil count, tumor size, and proportion of arterial phase hyperenhancement on 10x MRI (less than 50%, score 1, and at least 50%, score 0). resection (ASRAR) score to facilitate risk stratification of patients into high risk (ASRAR score of 15 < ) or low risk (ASRAR score < 15). According to the study, the diagnostic model included 302 patients in the training set and 128 patients in the test set.
The researchers found that the two-year concordance index (C-index) for the ASRAR score was 82%, compared with a range of 63% to 72% for eight other staging systems, including the Barcelona Clinic Liver Cancer (BCLC) and the Eighth U.S. Joint Committee on Cancer (AJCC) staging system. The ASRAR score also had a time-dependent area under the receiver operating characteristic curve (AUC) of 82% for predicting late recurrence of HCC, whereas the AUC of other staging systems ranged from 63% to 72%.
“More and more evidence supports the potential of imaging techniques, particularly contrast-enhanced MRI, to analyze HCC aggressiveness (e.g., pathological subtypes, microvascular invasion)…and prognosis (e.g., postoperative recurrence, extrahepatic metastases), ” write lead study author Hanyu Jiang, MD, Department of Radiology, West China Hospital and Sichuan University, Chengdu, China, and colleagues.
The study authors noted that an important finding of the study is that APHE below 50% on MRI predicts late HCC recurrence.
“Regions of hypoenhancement on imaging may represent intratumoral necrosis, fibrotic stroma, and/or hemorrhage in histopathological specimens, all of which are associated with poor prognosis in HCC,” Jiang and colleagues noted. “In addition, less than 50% of APHE have previously been associated with trabecular mass HCC, a pathological subtype associated with increased metastasis and poorer survival.”
Three main points
- ASRAR scoring model. The ASRAR (late recurrence after resection) score, calculated based on serum neutrophil count, tumor size, and proportion of arterial phase hyperenhancement on MRI, provides an advanced and effective risk stratification tool for HCC patients undergoing curative resection.
- Improved forecast accuracy. Compared with existing staging systems, the ASRAR score has excellent predictive accuracy for late HCC recurrence, with a two-year concordance index (C-index) of 82% and a time-dependent area under the receiver operating characteristic curve (AUC) of 82%. This score is superior to other staging systems such as BCLC and AJCC.
- Potential for adjuvant therapy in high-risk patients. The ASRAR score helps individualize prognosis and select adjuvant therapy for HCC patients determined to be at high risk for recurrence based on the ASRAR score. Patients with high-risk scores who received adjuvant therapy had significantly longer median recurrence-free survival compared with patients who did not receive adjuvant therapy, suggesting its potential utility in treatment decisions.
While the researchers note the lack of standardized and approved indications for the use of adjuvant therapy in HCC treatment, they note that risk stratification by the ASRAR score model suggests that adjuvant therapy has considerable potential for patients considered to be at high risk for HCC recurrence. benefits. Specifically, they found that the use of adjuvant therapy in this patient population was associated with more than three times the median recurrence-free survival (22.9 months) of high-risk patients who did not receive adjuvant therapy (7.2 months).
“These results suggest that the ASRAR score can serve as a decision-making tool for individualized prediction and adjuvant treatment selection,” Jiang and colleagues added.
(Editor’s note: For related content, see “Meta-analysis evaluates the impact of radiomics in predicting hepatocellular carcinoma recurrence,” “Can CT radiomics models improve risk assessment of large and small beam-mass hepatocellular carcinomas?” and “Liver Microvascular invasion of cellular carcinoma: Can it? “Is it an impact on CT radiomics models?”)
In addition to the inherent limitations of a retrospective single-center study, the researchers noted that prevalent chronic hepatitis B affected 97.8% of the study cohort, limiting the extrapolation of the study results to people without hepatitis B. The study authors also acknowledge that individualized use of complementary therapies that were more commonly used later in the study may also affect how the findings apply to the broader population. Given that the ASRAR score was developed in patients undergoing surgical resection, the researchers acknowledge that it may not be useful in evaluating patients undergoing liver transplantation.