Evaluation For Prediction Of Recurrence After Radiofrequency Ablation In Early Hepatocellular Carcinoma By Combination Of Mir-34a And Ivim-Dwi

The prognosis of hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA) is mainly associated with tumor recurrence. We previously demonstrated the expression of microRNA-34a (miR-34a) is involved in oncogenesis and progression of HCC, and suggested that the expression of miR-34a in HCC biopsy specimens has an independent predictive value of early recurrence after RFA. The aim of this study was to investigate the prognostic value of combined tissue miR-34a expression and non-CE MR Perfusion Imaging (IVIM-DWI) in patients with HCC treated with RFA. Patients with early-stage single-nodule HCC treated with RFA were included and underwent IVIM-DWI, and tissue expression of miR-34a was assessed by quantitative reverse-transcription polymerase chain reaction. Main clinical endpoints were overall and early recurrence. The Kaplan-Meier method was used to plot recurrence curves and univariable and multivariable Cox regression analyses were performed to assess independent predictive factors for recurrence. Of 135 patients, recurrence occurred in 73 patients (54.1%) with a median followup of 30 months. Forty-nine patients (36.3%) recurred within 2 years after RFA. The median miR-34a level was 0.87 (range 0.06-21.54). Low miR-34a level was associated with larger tumor size (P=0.033) and low parameter value of IVIM-DWI (P=0.043). The parameters obtained from IVIM-DWI were significantly positively correlated with the microvessel density (r=0.573 and 0.526, P=0.000 and 0.0000, respectively). When analyzed with a Cox regression model, the independent predictive factors for overall recurrence were low parameter value of IVIM-DWI (hazard ratio [HR]=1.26; 95% confidence interval [CI]=1.13-1.46; P=0.028), low miR-34a level (HR=1.38; 95% CI=1.22-1.56; P=0.011), high microvessel density (HR=1.42; 95% CI=1.03-1.62; P=0.010). In the evaluation of early recurrence after RFA, the sensitivity and specificity of miR-34a and IVIM-DWI combined were better than miR-34a or IVIM-DWI alone. Taken together, this study suggests that combination of miR-34a and IVIM-DWI can provide more comprehensive evaluation for the early recurrence after RFA of HCC, and should be recommended as an effective replace technique.