Identification of proliferative hepatocellular carcinoma using the SMARS score and implications for microwave ablation

Peng Zhou; Yan Bao; De-Hua Chang; Jun-Xiang Li; Tian-Zhi An; Ya-Ping Shen; Wen-Wu Cai; Lu Wen; Yu-Dong Xiao

doi:10.1186/s13244-024-01792-8

Identification of proliferative hepatocellular carcinoma using the SMARS score and implications for microwave ablation

Insights Imaging. 2024 Sep 10;15(1):220. doi: 10.1186/s13244-024-01792-8.

Authors

Peng Zhou^#¹, Yan Bao^#², De-Hua Chang³, Jun-Xiang Li⁴, Tian-Zhi An⁵, Ya-Ping Shen⁵, Wen-Wu Cai⁶, Lu Wen⁷, Yu-Dong Xiao⁸

Affiliations

¹ Department of Pathology, The Second Xiangya Hospital of Central South University, 410011, Changsha, China.
² Department of Radiology, The Second Xiangya Hospital of Central South University, 410011, Changsha, China.
³ Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland.
⁴ Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, 550004, Guiyang, China.
⁵ Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, 550004, Guiyang, China.
⁶ Department of Liver Surgery, The Second Xiangya Hospital of Central South University, 410011, Changsha, China.
⁷ Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 410013, Changsha, China.
⁸ Department of Radiology, The Second Xiangya Hospital of Central South University, 410011, Changsha, China. xiaoyudong222@csu.edu.cn.

^# Contributed equally.

Abstract

Objective: To compare therapeutic outcomes of predicted proliferative and nonproliferative hepatocellular carcinoma (HCC) after microwave ablation (MWA) using a previously developed imaging-based predictive model, the SMARS score.

Methods: This multicenter retrospective study included consecutive 635 patients with unresectable HCC who underwent MWA between August 2013 and September 2020. Patients were stratified into predicted proliferative and nonproliferative phenotypes according to the SMARS score. Overall survival (OS) and recurrence-free survival (RFS) were compared between the predicted proliferative and nonproliferative HCCs before and after propensity score matching (PSM). OS and RFS were also compared between the two groups in subgroups of tumor size smaller than 30 mm and tumor size 30-50 mm.

Results: The SMARS score classified 127 and 508 patients into predicted proliferative and nonproliferative HCCs, respectively. The predicted proliferative HCCs exhibited worse RFS but equivalent OS when compared with nonproliferative HCCs before (p < 0.001 for RFS; p = 0.166 for OS) and after (p < 0.001 for RFS; p = 0.456 for OS) matching. Regarding subgroups of tumor size smaller than 30 mm (p = 0.098) and tumor size 30-50 mm (p = 0.680), the OSs were similar between the two groups. However, predicted proliferative HCCs had worse RFS compared to nonproliferative HCCs in the subgroup of tumor size 30-50 mm (p < 0.001), while the RFS did not differ in the subgroup of tumor size smaller than 30 mm (p = 0.141).

Conclusion: Predicted proliferative HCCs have worse RFS than nonproliferative ones after MWA, especially in tumor size larger than 30 mm. However, the phenotype of the tumor may not affect the OS.

Critical relevance statement: Before performing microwave ablation for hepatocellular carcinoma, the tumor phenotype should be considered because it may affect the therapeutic outcome.

Key points: Proliferative hepatocellular carcinoma (HCC) may be identified using the SMARS score, an imaging-based predictive model. SMARS predicted proliferative HCCs have worse recurrence-free and equivalent overall survival compared to nonproliferative HCC after microwave ablation. Tumor phenotype should be considered before performing microwave ablation.

Keywords: Hepatocellular carcinoma; Imaging feature; Microwave ablation; Prognosis.

Abstract

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