Carcinoma hepatocelular hipointenso na fase hepatobiliar da ressonância magnética com ácido gadoxético prediz recorrência após a cirurgia? Uma revisão sistemática e metanálise
Data
2023-06-29
Autores
Braga, Fernanda Angeli 
Orientadores
D'Ippolito, Giuseppe
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Investigar se o carcinoma hepatocelular (CHC) hipointenso na fase hepatobiliar (FHB) da RM com ácido gadoxético no pré-tratamento é um marcador prognóstico para recorrência tumoral dentro de três anos após a cirurgia com intenção curativa (ressecção ou transplante hepático). Métodos: A revisão sistemática foi realizada nas bases de dados PubMed, Embase, Cochrane e LILACS. Artigos originais focados na avaliação da intensidade de sinal (IS) do CHC na FHB, bem como na recorrência após a cirurgia por pelo menos três anos foram incluídos no estudo. A razão de chances (OR) foi medida usando o método do inverso da variância e modelo de efeitos randômicos. A ferramenta Qualidade em Estudos Prognósticos (QUIPS) foi utilizada para avaliar a qualidade dos artigos incluídos. Resultados: Cinco estudos com total de 718 pacientes foram analisados. A chance de recorrência dentro de três anos após a cirurgia nos pacientes com CHC hipointenso na FHB foi 3,12 vezes maior do que nos pacientes com CHC hiperintenso na FHB (OR 3,12; IC 95% 1,27 – 7,68; p = 0,01). A heterogeneidade foi
moderada (I2 = 52%). O risco de viés no geral de cada artigo incluído foi baixo. Conclusões: O CHC hipointenso na FHB da RM com ácido gadoxético no pré- tratamento aumentou a chance de recorrência tumoral em pacientes tratados com ressecção ou transplante hepático. A IS do CHC na FHB pode ser considerada um biomarcador de imagem não invasivo de prognóstico do paciente.
Objective: The aim of the current study was to investigate whether hypointense hepatocellular carcinoma (HCC) in the hepatobiliary phase (HBP) on gadoxetic acid- enhanced MRI at pretreatment is a potential prognostic marker for tumor recurrence within three years after surgery conducted for a curative purpose (resection or liver transplantation). Methods: Systematic review was performed in the PubMed, Embase, Cochrane Library, and LILACS databases. Original articles focused on evaluating HCC signal intensity (SI) in HBP, as well as recurrence at least 3 years after surgery were included in the study. Odds ratio (OR) was measured based on the inverse variance method and the random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included articles. Results: Five studies with 718 patients, in total, were analyzed. The odds ratio of disease recurrence in patients with hypointense HCC in the HBP, within three years after surgery, was 3.12 times higher than that observed in patients with hyperintense HCC in the HBP (OR 3.12; 95% CI 1.27 - 7.68; p = 0.01). Heterogeneity was classified as intermediate (I2 = 52%). Articles included in the review overall presented a low risk of bias. Conclusions: Hypointense HCC in the HBP on gadoxetic acid- enhanced MRI at pretreatment has increased the likelihood of tumor recurrence in patients subjected to resection or liver transplantation. HCC SI in the HBP is a potential non-invasive imaging biomarker associated with patient prognosis.
Objective: The aim of the current study was to investigate whether hypointense hepatocellular carcinoma (HCC) in the hepatobiliary phase (HBP) on gadoxetic acid- enhanced MRI at pretreatment is a potential prognostic marker for tumor recurrence within three years after surgery conducted for a curative purpose (resection or liver transplantation). Methods: Systematic review was performed in the PubMed, Embase, Cochrane Library, and LILACS databases. Original articles focused on evaluating HCC signal intensity (SI) in HBP, as well as recurrence at least 3 years after surgery were included in the study. Odds ratio (OR) was measured based on the inverse variance method and the random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included articles. Results: Five studies with 718 patients, in total, were analyzed. The odds ratio of disease recurrence in patients with hypointense HCC in the HBP, within three years after surgery, was 3.12 times higher than that observed in patients with hyperintense HCC in the HBP (OR 3.12; 95% CI 1.27 - 7.68; p = 0.01). Heterogeneity was classified as intermediate (I2 = 52%). Articles included in the review overall presented a low risk of bias. Conclusions: Hypointense HCC in the HBP on gadoxetic acid- enhanced MRI at pretreatment has increased the likelihood of tumor recurrence in patients subjected to resection or liver transplantation. HCC SI in the HBP is a potential non-invasive imaging biomarker associated with patient prognosis.