Radiological prognosticators of hepatocellular carcinoma treated by hepatectomy

Kevin KW Chu, See Ching Chan, Sheung Tat Fan, Kenneth SH Chok, Tan To Cheung,
William W Sharr, Albert CY Chan and Chung Mau Lo
Hong Kong, China

BACKGROUND: Hepatectomy is the main curative treatment
for hepatocellular carcinoma (HCC), but postoperative longterm
survival is poor. Preoperative radiological features of HCC
displayed by computed tomography or magnetic resonance
imaging could serve as additional prognostic factors. This study
aimed to identify preoperative radiological features of HCC that
may be of prognostic significance in hepatectomy.
METHODS: Ninety-two patients who underwent hepatectomy
for HCC were included in this study. Preoperative radiological
features including tumor number, size, location (peripheral,
middle, central), portal vein invasion, hepatic vein invasion, and
presence of pseudo-capsule were analyzed in relation to survival.
RESULTS: With a median follow-up period of 41.7 months,
the 1-, 3- and 5-year overall survival rates were 85%, 65% and
58%, respectively. Univariate analysis showed that portal
vein invasion and absence of pseudo-capsule were significant
prognostic factors for overall survival, while all the examined
radiological features were prognostic factors for disease-free
survival. Multivariate analysis for overall survival found no
significant factor. On multivariate analysis for disease-free
survival, patients who had tumors with portal vein invasion
had poorer survival with a hazard ratio of 2.26 (95% CI,
1.05-4.91; P=0.038) and patients with single nodular HCC or
pseudo-capsulated HCC had better survival with a hazard
ratio of 0.50 (95% CI, 0.27-0.94; P=0.032) and 0.38 (95% CI,
0.14-0.99; P=0.048), respectively.
CONCLUSIONS: Demonstrable pseudo-capsule of HCC and
solitary HCC on imaging and absence of portal vein invasion are features associated with better disease-free survival after
hepatectomy. These features may guide treatment planning for
HCC.
(Hepatobiliary Pancreat Dis Int 2012;11:612-617)