Hanjun Zhang, Mingyue Song, Mingzhan Du, Hailong Huang, Ruirui Ma, Chenyi Ni, Linchuan Guo, Chunhong Hu, Weiguo Zhang
Preoperative Gd-EOB-DTPA-enhanced MRI features and elevated AFP were associated with an exploratory, endothelial-caliber-based VETC subtype and with VETC proportion in HCC. MaT-VETC, but not VETC proportion, showed an association with worse overall survival in this preliminary study; these hypothesis-generating findings require validation in larger, external cohorts before clinical application.
OBJECTIVES: To identify preoperative Gd-EOB-DTPA-enhanced MRI features and clinical variables predictive of an exploratory subtype and proportion of vessels encapsulating tumor clusters (VETC) in hepatocellular carcinoma (HCC), and to evaluate their preliminary prognostic value.
METHODS: This retrospective study included 211 patients with pathologically confirmed HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI (January 2015-December 2024). Patients were classified by exploratory VETC subtype and proportion. Predictive imaging features were identified using logistic regression, and the prognostic implications of VETC-based stratification were assessed by integrating relevant imaging and clinicopathological indices using Cox regression.
RESULTS: Macrotrabecular-VETC (MaT-VETC) (≥6 layers) was independently associated with satellite nodules (aOR 4.54, 95% CI: 1.46-14.08; p = 0.009) and low arterial-phase enhancement ratio (aOR 3.33, 95% CI: 1.22-9.17; p = 0.019). A complete enhancing capsule (aOR 2.63, 95% CI: 1.46-4.79; p = 0.001), lower hepatobiliary phase lesion-to-liver signal ratio (aOR 0.17, 95% CI: 0.06-0.52; p = 0.002), and smaller lesion size (aOR 0.51, 95% CI: 0.28-0.94; p = 0.031) independently predicted higher VETC proportion. Elevated AFP (≥300 µg/L) predicted both MaT-VETC (aOR 3.55, 95% CI: 1.12-11.27; p = 0.031) and higher VETC proportion (aOR 2.32, 95% CI: 1.28-4.23; p = 0.006). MaT-VETC was independently associated with worse overall survival (aHR 2.84, 95% CI: 1.03-7.78; p = 0.043), whereas higher VETC proportion showed a nonsignificant trend toward shorter survival (aHR 2.07, 95% CI: 0.78-5.48; p = 0.143).
CONCLUSIONS: Preoperative Gd-EOB-DTPA-enhanced MRI features and elevated AFP were associated with an exploratory, endothelial-caliber-based VETC subtype and with VETC proportion in HCC. MaT-VETC, but not VETC proportion, showed an association with worse overall survival in this preliminary study; these hypothesis-generating findings require validation in larger, external cohorts before clinical application.