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Complete tumor encapsulation on magnetic resonance imaging: A potentially useful imaging biomarker for better survival in solitary large hepatocellular carcinoma

Authors

  • David S. Lu,

    Corresponding author
    1. Pfleger Liver Institute and Department of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, Korea
    2. Department of Surgery, University of California Los Angeles, Los Angeles, CA, Korea
    • Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
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  • Surachate Siripongsakun,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
    2. Bangkok, Thailand
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  • Jeong Kyong Lee,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
    2. School of Medicine, Ewha Womans University, Seoul, Korea
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  • Sindy H. Wei,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
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  • Phillip M. Cheng,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
    2. Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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  • Saman Sabounchi,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
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  • Jong Seok Lee,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
    2. Asan Medical Center, Seoul, Korea
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  • Steven Raman,

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
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  • Myron J. Tong,

    1. Pfleger Liver Institute and Department of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, Korea
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  • Ronald W. Busuttil,

    1. Pfleger Liver Institute and Department of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, Korea
    2. Department of Surgery, University of California Los Angeles, Los Angeles, CA, Korea
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  • James Sayre

    1. Department of Radiology, University of California Los Angeles, Los Angeles, CA, Korea
    2. School of Public Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, Korea
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  • David S. Lu, Surachate Siripongsakun, Jeong Kyong Lee, and Phillip M. Cheng contributed to the study concept and design, the acquisition of data, the analysis and interpretation of data, the drafting of the manuscript, and a critical revision of the manuscript. Sindy H. Wei and Jong Seok Lee contributed to the study concept and design, the acquisition of data, and the analysis and interpretation of data. Saman Sabounchi contributed to the acquisition of data and the analysis and interpretation of data. Steven Raman contributed to the study concept and design, the acquisition of data, and a critical revision of the manuscript. Myron J. Tong and Ronald W. Busuttil contributed to the study concept and design, the analysis and interpretation of data, and a critical revision of the manuscript. James Sayre contributed to the analysis and interpretation of data and a critical revision of the manuscript.

Address reprint requests to David S. Lu, M.D., Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood plaza, Los Angeles, CA 90095. Telephone: 310-267-9788; FAX: 310-267-3635; E-mail: dlu@mednet.ucla.edu

Abstract

The aim of this study was to determine the prognostic value of complete tumor encapsulation as visualized on magnetic resonance imaging (MRI) in patients with a solitary large hepatocellular carcinoma (HCC) beyond the Milan criteria for liver transplantation (LT). Between December 2000 and March 2011, 57 patients who had a solitary HCC exceeding 5 cm in diameter at the time of initial MRI before any treatment were identified. MRI images of the patients were independently reviewed by 2 experienced readers for the presence of complete tumoral encapsulation. The medical records of the patients were reviewed for an outcome analysis. Thirty of the 57 patients had completely encapsulated HCC according to MRI. There was excellent interobserver agreement between the 2 readers for the assessment of complete encapsulation (κ=0.86). Overall survival was significantly longer for patients with completely encapsulated HCC versus patients with incompletely or nonencapsulated tumors (P<0.001), and this included a subanalysis of 33 patients who received locoregional treatment (LRT; P=0.04). The presence of complete encapsulation was a strong predictor for survival in these patients according to both univariate [hazard ratio (HR)=0.24, 95% confidence interval (CI)=0.12–0.52, P<0.001] and multivariate analyses (HR=0.25, 95% CI=0.07–0.85, P=0.03). The rates of down-staging (P<0.001) and eventual LT (P=0.02) after LRT were also significantly higher in the patients with completely encapsulated tumors. In conclusion, complete tumor encapsulation on MRI is a potentially useful predictor for favorable biology in patients with a solitary large HCC. This new imaging biomarker may have a role in treatment selection for patients whose tumors exceed the Milan criteria size limits. Liver Transpl 19:283–291, 2013. © 2013 AASLD.

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