Diagnostic Model for Proliferative HCC Using LI‐RADS: Assessing Therapeutic Outcomes in Hepatectomy and TKI‐ICI Combination

Abstract

BackgroundProliferative hepatocellular carcinoma (HCC), aggressive with poor prognosis, and lacks reliable MRI diagnosis.PurposeTo develop a diagnostic model for proliferative HCC using liver imaging reporting and data system (LI‐RADS) and assess its prognostic value.Study TypeRetrospective.Population241 HCC patients underwent hepatectomy (90 proliferative HCCs: 151 nonproliferative HCCs), divided into the training (N = 167) and validation (N = 74) sets. 57 HCC patients received combination therapy with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).Field Strength/Sequence3.0 T, T1‐ and T2‐weighted, diffusion‐weighted, in‐ and out‐phase, T1 high resolution isotropic volume excitation and dynamic gadoxetic acid‐enhanced imaging.AssessmentLI‐RADS v2018 and other MRI features (intratumoral artery, substantial hypoenhancing component, hepatobiliary phase peritumoral hypointensity, and irregular tumor margin) were assessed. A diagnostic model for proliferative HCC was established, stratifying patients into high‐ and low‐risk groups. Follow‐up occurred every 3–6 months, and recurrence‐free survival (RFS), progression‐free survival (PFS) and overall survival (OS) in different groups were compared.Statistical TestsFisher's test or chi‐square test, t‐test or Mann–Whitney test, logistic regression, Harrell's concordance index (C‐index), Kaplan–Meier curves, and Cox proportional hazards. Significance level: P < 0.05.ResultsThe diagnostic model, incorporating corona enhancement, rim arterial phase hyperenhancement, infiltrative appearance, intratumoral artery, and substantial hypoenhancing component, achieved a C‐index of 0.823 (training set) and 0.804 (validation set). Median follow‐up was 32.5 months (interquartile range [IQR], 25.1 months) for postsurgery patients, and 16.8 months (IQR: 13.2 months) for combination‐treated patients. 99 patients experienced recurrence, and 30 demonstrated tumor nonresponse. Differences were significant in RFS and OS rates between high‐risk and low‐risk groups post‐surgery (40.3% vs. 65.8%, 62.3% vs. 90.1%, at 5 years). In combination‐treated patients, PFS rates differed significantly (80.6% vs. 7.7% at 2 years).Data ConclusionThe MR‐based model could pre‐treatment identify proliferative HCC and assist in prognosis evaluation.Level of Evidence4.Technical EfficacyStage 2.