Daijiworld Media Network - London
London, Nov 8: MRI-based prediction models have demonstrated improved accuracy in identifying very early recurrence of hepatocellular carcinoma (HCC) following surgical removal of the tumour, outperforming established prognostic systems across international patient cohorts.
The findings indicate that combining imaging features with clinical information could help identify patients at increased risk of cancer recurrence within one year of surgery, potentially supporting more personalised follow-up and management strategies.
The international retrospective study included 1,851 patients who underwent curative-intent surgery for a single Barcelona Clinic Liver Cancer (BCLC) stage 0/A HCC across 14 hospitals. Researchers developed two MRI-based Very Early Recurrence Prediction (MERP) models using data from a derivation cohort of 628 patients.
The preoperative model, MERP-pre, incorporated serum alpha-fetoprotein (AFP) levels, tumour size, portal venous phase peritumoral hypoenhancement and intratumoral blood products. The postoperative model, MERP-post, included AFP levels, peritumoral hypoenhancement, intratumoral blood products and microvascular invasion.
Both models were externally validated in Eastern and Western cohorts comprising 775 and 178 patients, respectively. They were also evaluated in a computed tomography (CT) cohort of 230 patients.
The MERP models outperformed major staging systems and the IMbrave050 criteria across the test cohorts. Their concordance indices ranged from 0.685 to 0.790, compared with 0.524 to 0.682 for established prognostic systems. They also improved risk classification, with net reclassification improvement values ranging from 0.004 to 0.372.
Across all cohorts, the models consistently separated patients into high- and low-risk groups, which showed significantly different one-year recurrence-free survival (RFS) outcomes. In the CT cohort, MERP-post recorded a concordance index of 0.790, compared with 0.742 for MERP-pre.
Researchers also examined the biological characteristics associated with MERP-pre risk groups using whole-exome and RNA sequencing. Tumours classified as low risk showed features associated with the non-proliferative class, increased lipid catabolism and an immunoactive tumour microenvironment.
The researchers concluded that the MERP models could offer robust and generalisable tools for predicting very early HCC recurrence and help refine risk-based management strategies.
However, they cautioned that the findings were based on patients who underwent surgical resection and cannot be directly extrapolated to the wider BCLC stage 0/A population receiving non-surgical treatments.