Abstract
Background:
Hepatocellular carcinoma (HCC) patients with multiple tumors have a poor prognosis and need more attention. Therefore, we aim to find an easy-available radiologic indicator that can differentiate prognosis for BCLC-A patients with multiple tumors.
Methods:
Magnetic resonance imaging (MRI) of patients received thermal ablation, laparoscopic hepatectomy, or laparoscopic hepatectomy combined with thermal ablation from five tertiary hospitals were collected. Tumor distribution (TD) was classified into three types: same-segment, different-segments and different-lobes, and three junior doctors (< 5year-experience) were invited to classified classification. We compared disease-free survival (DFS) and overall survival (OS) among different TD types, and performed pathological consistency and classification analysis to explicate. Six pathological indicators (tumor differentiation, AFP, Arg-1, HepPar1, CK-19 and VEGF) were included.
Results:
373 patients were included with a 36.0-month median follow-up. Fleiss' kappa among three doctors was 0.803. Patients with same-segment type had better DFS and OS than different-segments (p < 0.001) and different-lobes (p < 0.001) type, so same-segment was defined as concentrated distribution. Different-segments and different-lobes type had comparable DFS (p = 0.072) and OS (p = 0.83), and were defined as dispersed distribution. Patients in concentrated group had higher pathological consistency in tumor-differentiation (96.2%vs86.7%, p = 0.003), AFP (95.3%vs84.4%, p = 0.005), Arg-1 (96.7%vs83.3%, p = 0.001) and CK-19 (96.0%vs82.4%, p = 0.004), and better tumor-differentiation (23.3%vs41.7%, p < 0.001) and lower expression rate in AFP (36.8%vs49.5%, p = 0.035), CK-19 (9.3%vs24.3%, p = 0.008) and VEGF (17.0%vs39.3%, p = 0.004) than dispersed group.
Conclusion:
MRI can accurately classify tumor distribution type of multiple tumors for patients in BCLC-A stage, and patients with concentrated distribution tumors have better prognosis than patients with dispersed distribution.