title: Complete tumor encapsulation on magnetic resonance imaging: a potentially useful imaging biomarker for better survival in solitary large hepatocellular carcinoma.
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.
authors.affiliation: Department of Radiology, University of California Los Angeles, Los Angeles, CA 90095, USA. dlu@mednet.ucla.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Lu
authors.forename: Surachate
authors.initials: S
authors.lastname: Siripongsakun
authors.forename: Jeong
authors.initials: J
authors.lastname: Kyong Lee
authors.forename: Sindy H
authors.initials: SH
authors.lastname: Wei
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Cheng
authors.forename: Saman
authors.initials: S
authors.lastname: Sabounchi
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Steven
authors.initials: S
authors.lastname: Raman
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: James
authors.initials: J
authors.lastname: Sayre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D005355:Fibrosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden; D055815:Young Adult