我们的目标是评估和验证与慢性肝病患者异质性靶样原发性肝恶性肿瘤手术治疗后复发和生存相关的影像和临床因素，并开发分级风险评估的评分系统。该多中心回顾性研究纳入了197名慢性肝病患者，其术前通过有机磷酸盐类造影剂增强MRI检测到单个目标性原发性肝恶性肿瘤（142例肝细胞癌，37例胆管癌，17例混合型肝细胞-胆管癌和1例神经内分泌癌），并在2010年至2017年期间实施手术切除。其中，120名患者构成了开发组，另外77名患者来自不同的机构，用作外部验证组。使用Cox比例风险模型分析鉴定与复发无关生存和总体生存相关的因素，并制定风险评分。使用Harrell C-index评价外部验证组的风险评分的判别力。采用Kaplan-Meier曲线评估不同风险评分组的复发无关生存和总体生存情况。 在排除仅在肝胆相位可见的特征的RFS1模型中，包括直径为2-5 cm或 >5 cm的肿瘤大小，薄环动脉期高增强以及。在RFS2模型中，包括肿瘤直径 >5 cm，静脉内肿瘤（TIV），以及HBP低信号结节而无APHE的肿瘤。生存模型包括直径 >5 cm的肿瘤大小，薄环APHE，TIV和TIV以外的肿瘤血管受累。模型的风险评分在外部验证组中具有良好的判别能力（C-index为0.62-0.76）。风险评分将患者分为三个风险组：有利、中等和不良，每个组的生存结局都不同（所有log-rank p < 0.05）。基于薄环动脉增强模式、肿瘤大小、HBP结果和影像血管侵犯状况的风险评分可能有助于预测目标性原发性肝恶性肿瘤患者手术后的RFS和OS。版权所有 ©2023年韩国放射学会。

We aimed to assess and validate the radiologic and clinical factors that were associated with recurrence and survival after curative surgery for heterogeneous targetoid primary liver malignancies in patients with chronic liver disease and to develop scoring systems for risk stratification.This multicenter retrospective study included 197 consecutive patients with chronic liver disease who had a single targetoid primary liver malignancy (142 hepatocellular carcinomas, 37 cholangiocarcinomas, 17 combined hepatocellular carcinoma-cholangiocarcinomas, and one neuroendocrine carcinoma) identified on preoperative gadoxetic acid-enhanced MRI and subsequently surgically removed between 2010 and 2017. Of these, 120 patients constituted the development cohort, and 77 patients from separate institution served as an external validation cohort. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were identified using a Cox proportional hazards analysis, and risk scores were developed. The discriminatory power of the risk scores in the external validation cohort was evaluated using the Harrell C-index. The Kaplan-Meier curves were used to estimate RFS and OS for the different risk-score groups.In RFS model 1, which eliminated features exclusively accessible on the hepatobiliary phase (HBP), tumor size of 2-5 cm or > 5 cm, and thin-rim arterial phase hyperenhancement (APHE) were included. In RFS model 2, tumors with a size of > 5 cm, tumor in vein (TIV), and HBP hypointense nodules without APHE were included. The OS model included a tumor size of > 5 cm, thin-rim APHE, TIV, and tumor vascular involvement other than TIV. The risk scores of the models showed good discriminatory performance in the external validation set (C-index, 0.62-0.76). The scoring system categorized the patients into three risk groups: favorable, intermediate, and poor, each with a distinct survival outcome (all log-rank p < 0.05).Risk scores based on rim arterial enhancement pattern, tumor size, HBP findings, and radiologic vascular invasion status may help predict postoperative RFS and OS in patients with targetoid primary liver malignancies.Copyright © 2023 The Korean Society of Radiology.