Predictive value of gadoxetic acid-enhanced MRI combined with CK19 and microvascular invasion for postoperative recurrence of hepatocellular carcinoma

WANG Shaogang; ZHANG Tao; ZHANG Xueqin; XU Lei

doi:10.19300/j.2025.L21858

Abstract：Objective To investigate the predictive value of gadoxetic acid-enhanced MRI features and clinicopathological characteristics for postoperative recurrence in patients with hepatocellular carcinoma(HCC).Methods A retrospective cohort of 209 patients with pathologically confirmed HCC who underwent surgical resection was analyzed.Based on postoperative follow-up results,patients were divided into a recurrence group(n=82)and a non-recurrence group(n=127).Clinicopathological parameters and MRI features were compared between groups.A nomogram model for predicting postoperative recurrence-free survival(RFS)in HCC patients was constructed based on the results of multivariate Cox regression analysis.Model performance was assessed using receiver operating characteristic(ROC)curve analysis,calibration curve analysis,and decision curve analysis(DCA).Kaplan-Meier curves were generated to compare RFS between subgroups,and the Log-rank test was used for statistical comparison.Results Multivariate Cox regression identified CK19 positivity,microvascular invasion(MVI)positivity,and the presence of the mosaic sign as independent risk factors for postoperative recurrence of HCC(all P＜0.05).The nomogram model demonstrated a higher area under the ROC curve(AUC)compared with any single factor(CK19,MVI,or mosaic sign).The model showed good fit and calibration,and DCA demonstated good clinical utility.Median RFS was 30 months for CK19-positive patients,17 months for MVI-positive patients,and 26 months for patients with mosaic sign positivity.Differences in 1-,2-,and 3-year RFS rates according to CK19,MVI,and mosaic sign status were statistically significant(Log-rank test,all P＜0.05).Conclusion CK19 positivity,MVI positivity,and mosaic sign positivity are independent risk factors for postoperative recurrence of HCC,and may serve as potential biomarkers for predicting poor prognosis after curative resection.