Prediction of microvascular invasion in combined hepatocellular-cholangiocarcinoma based on preoperative contrast-enhanced CT and clinical data. Issue 163 (June 2023)

• Record Type: Journal Article
• Authors: Zhang, Juan; Dong, Wei; Li, Yinqiao; Fu, Jiazhao; Jia, Ningyang
• Is Part Of: European journal of radiology. Issue 163(2023)
• Publication Date: 2023-06
• Subjects: Liver neoplasms -- Neoplasm invasion -- Tomography -- X-ray computed; AFP Alpha-fetoprotein -- APHE Arterial phase hyperenhancement -- AUC Area under the curve -- CA19-9 Cancer antigen 19-9 -- CEA Carcinoembryonic antigen -- CECT Contrast-enhanced CT -- CEUS Contrast-enhanced ultrasound -- cHCC-CCA Combined hepatocellularcholangiocarcinoma -- CI Confidence interval -- HBV Hepatitis B virus -- HCC Hepatocellular carcinoma -- ICC Intrahepatic cholangiocarcinoma -- LI-RADS Liver Imaging Reporting and Data System -- MVI Microvascular invasion -- OR Odds ratio -- PIVKA-II Protein induced by vitamin K absence or antagonist-II -- PLC Primary liver cancer -- ROC Receiver operating characteristic; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2023.110839
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Objective: Microvascular invasion (MVI) is significantly associated with prognosis in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) patients. The study aimed to explore the value of preoperative contrast-enhanced CT (CECT) features and clinical data in predicting MVI of cHCC-CCA. Methods: A total of 33 patients with MVI-positive and 27 with MVI-negative were enrolled, and underwent preoperative CECT imaging from January 2016 to December 2021. Preoperative clinical data and CECT imaging features were retrospectively analyzed. Univariable and multivariable logistic regression analysis were performed to identify potential predictors of MVI in cHCC-CCA. The diagnostic performance was evaluated by the receiver operating characteristic (ROC) curve and its area under the curve (AUC) value. Results: The mean age of the patients was 54.0 ± 10.3 years, and 53 of the 60 patients (88.3%) were male. Preoperative imaging features on CECT (non-smooth contour and arterial phase peritumoral enhancement) and clinical data (hepatitis B virus (HBV) infection and protein induced by vitamin K absence or antagonist-II (PIVKA-II)) were highly distinct between those in MVI-positive group and MVI-negative group. On multivariable logistic analysis, arterial phase peritumoral enhancement (odds ratio (OR), 6.514; 95% confidence interval (CI), 1.588–26.728, p = 0.012) and high serum PIVKA-II level (OR, 6.810; 95% CI, 1.796–25.820, p = 0.005) were independent predictors associated with MVI of cHCC-CCA. The combination of these two predictors had high sensitivity (31/33, 93.9%; 95% CI, 80.4% − 98.3%) in the prediction of MVI with an area under the receiver operating characteristic (ROC) curve of 0.763 (95% CI, 0.635–0.863). Conclusions: The findings indicated that arterial phase peritumoral enhancement on preoperative CECT and high serum PIVKA-II level were identified as potential predictors for MVI in cHCC-CCA patients.