Preoperative CT for Characterization of Aggressive Macrotrabecular-Massive Subtype and Vessels That Encapsulate Tumor Clusters Pattern in Hepatocellular Carcinoma

Background: Macrotrabecular-massive (MTM) subtype and vessels encapsulating tumor clusters (VETC) pattern of hepatocellular carcinoma (HCC) are associated with unfavorable prognosis. Purpose: To estimate the potential of preoperative CT in the prediction of MTM subtype and VETC pattern. Materials and Methods: Patients who underwent surgical resection or liver transplant and preoperative CT for HCC between January 2015 and June 2018 were retrospectively included in the primary cohort. CT imaging features were evaluated by two radiologists. Predictors associated with the MTM subtype or VETC pattern were determined by using logistic regression analyses and the performance was tested in a validation cohort. Prognostic factors associated with early recurrence after surgical resection were identified by using Cox regression analyses. Results: The primary cohort included 170 patients (median age, 55 years; interquartile range, 48-63 years; 152 men). Serum alpha-fetoprotein level higher than 100 ng/mL (odds ratio [OR], 4.3; 95% CI: 2.1, 9.2; P < .001), intratumor necrosis (OR, 5.2; 95% CI: 2.5, 11.0; P < .001), and intratumor hemorrhage (OR, 5.4; 95% CI: 1.3, 23.3; P = .02) were independent predictors for MTM subtype, whereas tumor size greater than 5 cm (OR, 3.8; 95% CI: 1.7, 8.1; P = .001) and intratumor necrosis (OR, 2.1; 95% CI: 1.0, 4.4; P = .045) were independent predictors for VETC pattern. These features were used for the construction of ANH and SN scores (where A is alpha-fetoprotein level, N is necrosis, H is hemorrhage, and S is size), respectively, which showed comparable prediction performance in the primary and validation cohorts. Preoperative high ANH and high SN phenotype (hazard ratio, 1.9; 95% CI: 1.2, 3.0; P = .01) was independently associated with early recurrence after surgical resection. Conclusion: Preoperative CT features could be used for the characterization of macrotrabecular-massive subtype and vessels that encapsulate tumor clusters pattern and were of prognostic significance for early recurrence in patients with hepatocellular carcinoma. Published under a CC BY 4.0 license.

Automated summary

This study aimed to evaluate the potential of preoperative CT in predicting the MTM subtype and VETC pattern of HCC. Specific CT imaging features were identified as predictors for tumor subtype, leading to the development of prognostic scoring systems. The predictive performance was validated in a separate cohort, with high ANH and high SN phenotype being independently associated with early recurrence after surgical resection.