Dong Ho Lee1, Jeong Min Lee2,3, Mi Hye Yu4, Bo Yun Hur5, Nam-Joon Yi6, Kwang-Woong Lee6, Kyung-Suk Suh6, Jung-Hwan Yoon7, Yoon Jun Kim7, Jeong-Hoon Lee7, Su Jong Yu7, Joon Koo Han1,8. 1. Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea. 2. Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea. jmsh@snu.ac.kr. 3. Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea. jmsh@snu.ac.kr. 4. Department of Radiology, Konkuk University School of Medicine, Seoul, South Korea. 5. Department of Radiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea. 6. Department of Surgery, Seoul National University Hospital, Seoul, South Korea. 7. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. 8. Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
Abstract
OBJECTIVE: This study was conducted in order to evaluate whether the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules can help determine the treatment method for single nodular hepatocellular carcinoma (HCC) ≤ 3 cm. METHODS: This study was approved by the institutional review board. A total of 345 patients with single nodular HCC ≤ 3 cm underwent pretreatment gadoxetic acid-enhanced MR followed by hepatic resection (n = 123) or radiofrequency ablation (RFA) (n = 222). We retrospectively analyzed the results of tumor recurrence according to the presence of nonhypervascular HBP hypointense nodules at each treatment method. RESULTS: Nonhypervascular HBP hypointense nodules were found in 18 of 123 patients treated by hepatic resection and in 63 of 222 patients who underwent RFA. The presence of nonhypervascular HBP hypointense nodules was a significant affecting factor for recurrence-free survival (RFS) after both hepatic resection (p = 0.004, hazard ratio [HR] = 2.75 [1.38-5.51]) and RFA (p = 0.004, HR = 1.78 [1.20-2.63]). In patients with nonhypervascular HBP hypointense nodules, 5-year RFS was 34.0% after hepatic resection, which was not significantly different from the 28.0% after RFA (p = 0.618). However, in patients without nonhypervascular HBP hypointense nodules, 5-year RFS was 65.0% after hepatic resection, which was significantly better than the 51.0% after RFA (p = 0.042), owing to significantly lower cumulative incidence of local tumor progression after hepatic resection (p < 0.001). CONCLUSIONS: While the presence of nonhypervascular HBP hypointense nodules on gadoxetic acid-enhanced MR taken prior to treatment was a significant predictive factor of tumor recurrence after both hepatic resection and RFA, in patients without nonhypervascular HBP hypointense nodules, hepatic resection can provide significantly better RFS than RFA. KEY POINTS: • The presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules was a significant risk factor for tumor recurrence after either hepatectomy or radiofrequency ablation (RFA). • Hepatectomy provided significantly better recurrence-free survival than RFA in patients without nonhypervascular HBP hypointense nodules. • In patients with nonhypervascular HBP hypointense nodules, recurrence-free survival after RFA was comparable to hepatectomy.
OBJECTIVE: This study was conducted in order to evaluate whether the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules can help determine the treatment method for single nodular hepatocellular carcinoma (HCC) ≤ 3 cm. METHODS: This study was approved by the institutional review board. A total of 345 patients with single nodular HCC ≤ 3 cm underwent pretreatment gadoxetic acid-enhanced MR followed by hepatic resection (n = 123) or radiofrequency ablation (RFA) (n = 222). We retrospectively analyzed the results of tumor recurrence according to the presence of nonhypervascular HBP hypointense nodules at each treatment method. RESULTS:Nonhypervascular HBP hypointense nodules were found in 18 of 123 patients treated by hepatic resection and in 63 of 222 patients who underwent RFA. The presence of nonhypervascular HBP hypointense nodules was a significant affecting factor for recurrence-free survival (RFS) after both hepatic resection (p = 0.004, hazard ratio [HR] = 2.75 [1.38-5.51]) and RFA (p = 0.004, HR = 1.78 [1.20-2.63]). In patients with nonhypervascular HBP hypointense nodules, 5-year RFS was 34.0% after hepatic resection, which was not significantly different from the 28.0% after RFA (p = 0.618). However, in patients without nonhypervascular HBP hypointense nodules, 5-year RFS was 65.0% after hepatic resection, which was significantly better than the 51.0% after RFA (p = 0.042), owing to significantly lower cumulative incidence of local tumor progression after hepatic resection (p < 0.001). CONCLUSIONS: While the presence of nonhypervascular HBP hypointense nodules on gadoxetic acid-enhanced MR taken prior to treatment was a significant predictive factor of tumor recurrence after both hepatic resection and RFA, in patients without nonhypervascular HBP hypointense nodules, hepatic resection can provide significantly better RFS than RFA. KEY POINTS: • The presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules was a significant risk factor for tumor recurrence after either hepatectomy or radiofrequency ablation (RFA). • Hepatectomy provided significantly better recurrence-free survival than RFA in patients without nonhypervascular HBP hypointense nodules. • In patients with nonhypervascular HBP hypointense nodules, recurrence-free survival after RFA was comparable to hepatectomy.
Entities:
Keywords:
Ablation technique; Hepatectomy; Hepatocellular carcinoma; Magnetic resonance imaging
Authors: S Nahum Goldberg; Clement J Grassi; John F Cardella; J William Charboneau; Gerald D Dodd; Damian E Dupuy; Debra Gervais; Alice R Gillams; Robert A Kane; Fred T Lee; Tito Livraghi; John McGahan; David A Phillips; Hyunchul Rhim; Stuart G Silverman Journal: Radiology Date: 2005-04-21 Impact factor: 11.105