Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) patients with multiple tumors have a poor prognosis and need more attention. OBJECTIVES: To develop an easily available radiological indicator that can differentiate the prognosis of Barcelona Clinic Liver Cancer stage A (BCLC-A) patients with multiple tumors. DESIGN: This was a retrospective, multicenter study. Magnetic resonance imaging (MRI) data were collected from patients who underwent thermal ablation (TA), laparoscopic hepatectomy (LH), or LH combined with TA at five tertiary hospitals. METHODS: Tumor distribution (TD) was classified into three types: same-segment, different-segments, and different-lobes, and three junior doctors (<5 years of experience) were invited to classify the tumors. We compared disease-free survival (DFS) and overall survival (OS) among the different TD types and performed pathological consistency and classification analyses. Six pathological indicators (tumor differentiation, alpha-fetoprotein (AFP), arginase-1 (Arg-1), hepatocyte paraffin 1, cytokeratin-19 (CK-19), and vascular endothelial growth factor (VEGF)) were included. RESULTS: A total of 373 patients were included with a 36.0-month median follow-up. The Fleiss kappa score among the three doctors was 0.803. Patients with the same-segment type had better DFS and OS than those with different-segment (p < 0.001) and different-lobe (p < 0.001) types; therefore, the same segment was defined as a concentrated distribution. Different segments and lobes had comparable DFS (p = 0.072) and OS (p = 0.830) and were defined as having dispersed distributions. Patients in concentrated group had higher pathological consistency in tumor-differentiation (96.2% vs 86.7%, p = 0.003), AFP (95.3% vs 84.4%, p = 0.005), Arg-1 (96.7% vs 83.3%, p = 0.001) and CK-19 (96.0% vs 82.4%, p = 0.004), and better tumor-differentiation (23.3% vs 41.7%, p < 0.001) and lower expression rate in AFP (36.8% vs 49.5%, p = 0.035), CK-19 (9.3% vs 24.3%, p = 0.008), and VEGF (17.0% vs 39.3%, p = 0.004) than dispersed group. CONCLUSION: We established a method based on MRI to accurately differentiate the TD type of multiple tumors for patients in the BCLC-A stage. Patients with concentrated distribution tumors had a better prognosis than patients with dispersed distribution.