LI-RADS Classification May Help Risk-Stratify Patients With iCCA

Preoperative liver imaging may help physicians better understand whether a patient is likely to experience recurrence following curative resection of intrahepatic cholangiocarcinoma (iCCA).

A new multicenter report published in Journal of Magnetic Resonance Imaging shows imaging classifications using the Liver Imaging Reporting and Data System (LI-RADS) correlate with 5-year recurrence-free survival (RFS) rates. The findings suggest LI-RADS classification based on contrast-enhanced MRI could be an important prognostic marker, alongside other factors like tumor size.

The authors explained that in patients with iCCA, complete tumor resection is the only potential curative treatment option. However, many patients still go on to experience recurrence after surgery, and the only widely accepted independent predictors of recurrence risk are factors such as lymphovascular and perineural invasion and lymph node metastasis, which can only be determined following the procedure itself.

The authors said preoperative imaging may offer an opportunity to better understand recurrence risk even before resection.

“Using LI-RADS when evaluating the imaging studies of high-risk patients may help ensure consistent and objective image analysis,” they wrote. If such consistency were achieved, it might be possible to assign recurrence risk based on LI-RADS assessment, they added.

LI-RADS was designed to help assess increased risk for hepatocellular carcinoma (HCC), a disease that has many of the same risk factors as iCCA. Scores can range from LR-1, which means a lesion is benign, to LR-5, a classification indicating malignancy that meets the criteria for HCC. In addition, the scoring system has other classifications, such as LR-M, which means a definite or likely malignancy, but which does not meet the criteria for HCC.

To test the potential for LI-RADS in assessing recurrence risk, the investigators conducted a retrospective, multicenter study in which 113 patients who underwent preoperative MRI and then curative surgical resection were categorized using LI-RADS and then tracked for long-term outcomes.

Most of the patients in the study (n = 93; 82.3%) were categorized as LR-M using LI-RADS. However, 17.7% were categorized as LR-4 or LR-5. The outcomes data showed that the latter group had significantly better outcomes.

Classification as LR-M and with tumor sizes in excess of 3 cm were both found to be independent risk factors for poor RFS. In addition, patients with LR-4 or LR-5 classifications had a 94.4% 5-year RFS rate compared with 51.9% seen among patients with an LR-M classification.

“Taken together, these findings suggest that the LI-RADS category may provide valuable prognostic implications for primary hepatic malignancy, regardless of the pathologic diagnosis,” the investigators concluded. They said their findings align with previous research looking at the potential of LI-RADS as a predictor of outcomes in patients with primary liver cancer.

The authors cautioned that because their study population was limited to people with single iCCAs, it is likely that the group includes patients with preserved liver function and lower tumor staging and thus are likely to have superior outcomes. They added that three-quarters of patients in this study had hepatitis B, so they said the study may have limited generalizability to other disease etiologies.

They concluded that further, larger studies will be needed to confirm the findings.

Reference

Hwang JA, Lee S, Lee JE, Yoon J, Choi SY, Shin J. LI-RADS category on MRI is associated with recurrence of intrahepatic cholangiocarcinoma after surgery: a multicenter study. J Magn Reson Imaging. Published online July 14, 2022. doi:10.1002/jmri.28354