ArticleJournal of hepatocellular carcinoma2026
A Preoperative MRI-Based Score to Predict High-Risk Pathology and Stratify Adjuvant Therapy Benefit in BCLC 0/A Hepatocellular Carcinoma.
Article in Journal of hepatocellular carcinoma, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: This study aims to develop and validate a magnetic resonance imaging (MRI)-based preoperative scoring model for predicting microvascular invasion (MVI) or Edmondson-Steiner grade 3/4 in BCLC 0/A hepatocellular carcinoma (HCC) and explore its potential for early recurrence risk stratification and as a hypothesis-generating tool for identifying patients who may benefit from adjuvant therapy. Materials and Methods: This multicenter retrospective study comprised consecutive patients with BCLC 0/A HCC who underwent contrast-enhanced MRI followed by curative resection at three different institutions between January 2015 and November 2024. To identify imaging predictors of MVI and Edmondson-Steiner grade 3/4, multivariable logistic regression was applied to the training set. Imaging features and AFP levels were combined to create a scoring system (HRI-score), and the model's ability to predict recurrence and stratify recurrence-free survival (RFS) was assessed in internal and external sets. Results: Overall, 994 patients were included (training: n = 601; internal validation: n = 257; external outcome set: n = 136). The HRI-score included irregular tumor morphology, nonperipheral washout, intratumoral blood products, and AFP (≥ 400 ng/mL). The training and internal validation sets had AUCs of 0.813 and 0.747, respectively. Across all sets, RFS was significantly lower in HRI-positive patients than for HRI-negative patients (all Conclusion: The HRI-score enables preoperative prediction of high-risk pathological features and risk stratification in BCLC 0/A HCC. It may also serve as a hypothesis-generating tool to identify patients who could potentially benefit from adjuvant therapy, warranting further prospective multicenter validation.
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