Liver stiffness measured by MR elastography is a predictor of early HCC recurrence after treatment

• Published in: European radiology Vol. 30; no. 8; pp. 4182 - 4192
• Main Authors: Cho, Hyo Jung, Kim, Bohyun, Kim, Hye Jin, Huh, Jimi, Kim, Jai Keun, Lee, Jei Hee, Seo, Chul Won, Ahn, Hye Ri, Eun, Jung Woo, Kim, Soon Sun, Cho, Sung Won, Cheong, Jae Youn
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2020; Springer Nature B.V
• Subjects: Ablation; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Catheter Ablation; Chemoembolization, Therapeutic - adverse effects; Confidence intervals; Criteria; Diagnostic Radiology; Diagnostic systems; Elasticity Imaging Techniques; Female; Gastrointestinal; Hepatectomy; Hepatocellular carcinoma; Humans; Imaging; Internal Medicine; Interventional Radiology; Kaplan-Meier Estimate; Liver; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Magnetic resonance; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neuroradiology; Proportional Hazards Models; Radio frequency; Radiology; Ratings; Regression analysis; Retrospective Studies; Risk analysis; Risk Factors; Stiffness; Subgroups; Treatment Outcome; Ultrasound; Recurrence; Hepatocellular carcinoma; Magnetic resonance elastography; Prognosis; Liver fibrosis
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-06792-y

Objectives
Magnetic resonance elastography (MRE) is a non-invasive tool for measuring liver stiffness (LS) with high diagnostic accuracy. This study investigated whether quantified LS by MRE could predict early recurrence of patients with hepatocellular carcinoma (HCC) within the Milan criteria.
Methods
A prospectively collected cohort, which included the HCC patients who underwent MRE before treatment (an HCC-MRE cohort), was analyzed. In the HCC-MRE cohort, only patients under the Milan criteria, who underwent hepatic resection, radiofrequency ablation (RFA), or transarterial chemoembolization (TACE), were reviewed. We investigated whether LS assessed by MRE was an independent predictor of early recurrence using Cox regressions and Kaplan-Meier analyses.
Results
A total of 192 HCC patients under the Milan criteria who underwent hepatic resection (
n
 = 96), RFA (
n
 = 23), or TACE (
n
 = 73) were included. Higher LS ratings (kPa; hazard ratio [HR] = 1.12; 95% confidence interval [CI] = 1.01–1.25;
p
 = 0.040) emerged as an independent risk factor for early tumor recurrence. In the subgroup analysis, higher LS ratings were associated with higher risks of early HCC recurrence in both the resection/RFA group (> 4.5 kPa; HR = 2.95; 95% CI = 1.26–6.94;
p
 = 0.013) and the TACE group (> 6 kPa; HR = 2.94; 95% CI = 1.27–6.83;
p
 = 0.012).
Conclusion
LS assessed by MRE was an independent predictor of early recurrence among HCC patients under the Milan criteria after achieving a complete response.
Key Points
• Liver parenchymal stiffness measured by MRE predicts early recurrence of treated HCC under Milan criteria.
• A liver stiffness > 5.5 kPa was associated with worse recurrence-free survival.
• Patients with high pre-treatment LS may benefit from stringent follow-up.