MRI-based prediction of the need for wide resection margins in patients with single hepatocellular carcinoma

Objectives

To develop an MRI-based score that enables individualized predictions of the survival benefit of wide over narrow resection margins.

Materials and methods

This single-center retrospective study (December 2011 to May 2022) included consecutive patients who underwent curative-intent resection for single Barcelona Clinic Liver Cancer (BCLC) 0/A HCC and preoperative contrast-enhanced MRI. In patients with narrow resection margins, preoperative demographic, laboratory, and MRI variables independently associated with early recurrence-free survival (RFS) were identified using Cox regression analyses, which were employed to develop a predictive score (named “MARGIN”). Survival outcomes were compared between wide and narrow resection margins in a propensity-score matched cohort for the score-stratified low- and high-risk groups, respectively.

Results

Four hundred nineteen patients (median age, 54 years; 361 men) were included, 282 (67.3%) undergoing narrow resection margins. In patients with narrow resection margins, age, alpha-fetoprotein (AFP) > 400 ng/mL, protein induced by vitamin K absence or antagonist-II (PIVKA-II) > 200 mAU/mL, radiological involvement of liver capsule, and infiltrative appearance were associated with early RFS (p values, 0.002–0.04) and formed the MARGIN score with a testing dataset C-index of 0.75 (95% CI: 0.65–0.84). In the matched cohort, wide resection margin was associated with improved early RFS rate for the high-risk group (MARGIN score ≥ − 1.3; 71.1% vs 41.0%; p = 0.02), but not for the low-risk group (MARGIN score < − 1.3; 79.7% vs 76.1%; p = 0.36).

Conclusion

In patients with single BCLC 0/A HCC, the MARGIN score may serve as promising decision-making to indicate the need for wide resection margins.

Clinical relevance statement

The MARGIN score has the potential to identify patients who would benefit more from wide resection margins than narrow resection margins, improving the postoperative survival of patients with single BCLC 0/A hepatocellular carcinoma (HCC).

Key Points

Age, AFP, PIVKA-II, radiological involvement of liver capsule, and infiltrative appearance were associated with early RFS and formed the MARGIN score.

The MARGIN score achieved a testing dataset C-index of 0.75.

Wide resection margins were associated with improved early RFS for the high-risk group, but not for the low-risk group.

Graphical Abstract