Enhanced patterns on intraoperative contrast-enhanced ultrasonography predict outcomes after curative liver resection in patients with hepatocellular carcinoma

Ikuo Nakamura, Etsuro Hatano, Masaharu Tada, Yusuke Kawabata, Shinjiro Tamagawa, Ami Kurimoto, Hideaki Iwama, Kan Toriguchi, Hideaki Sueoka, Kenjiro Iida, Masahiro Yoshida, Takashi Nishimura, Hiroko Iijima

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Purpose: This study aimed to clarify what hepatocellular carcinoma (HCC) phenotype, as categorized by intraoperative contrast-enhanced ultrasonography (CEUS), showed a high risk of recurrence after hepatic resection. Methods: Patients who underwent initial curative hepatectomy with intraoperative CEUS for a single HCC nodule were retrospectively assigned to three patterns of fine (FI), vascular (VA), and irregular (IR) according to the maximum intensity projection pattern based on intraoperative CEUS. Staining was performed for Ki-67, pyruvate kinase type M2 (PKM2), and vascular endothelial growth factor (VEGF) to assess the tumor proliferative activity, tumor glucose metabolism, and angiogenesis, respectively. Results: Of 116 patients, 18, 50, and 48 were assigned to the FI, VA and IR patterns, respectively. IR patients demonstrated a significantly worse prognosis for both the recurrence-free survival (RFS) and overall survival (OS) (P = 0.0002, 0.0262, respectively) than did patients with other patterns. A multivariate analysis revealed an IR pattern in intraoperative CEUS to be an independent predictive factor for a poor RFS, and major hepatectomy and an IR pattern were independent predictive factors for a poor OS. An IR pattern was closely related to the tumor size (≥ 3.3 cm) and poor histological differentiation and showed a high Ki-67 index, low VEGF expression, and high PKM2 expression. Conclusion: IR-pattern HCCs as classified by intraoperative CEUS may be associated with a higher risk of recurrence and worse outcomes in HCC patients after hepatic resection than other patterns.

Original languageEnglish
Pages (from-to)764-776
Number of pages13
JournalSurgery Today
Volume51
Issue number5
DOIs
Publication statusPublished - 05-2021
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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