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Zhang et al. Hepatoma Res 2020;6:30 Hepatoma Research
DOI: 10.20517/2394-5079.2020.17

Review Open Access

Imaging biomarkers for predicting poor prognosis of
hepatocellular carcinoma: a review

Yun Zhang , Zi-Xing Huang , Jie Chen , Yu-Jun Shi , Han-Yu Jiang , Li-Kun Cao , Bin Song 1
3
1
2
1
1
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1 Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
2 Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan
University, Chengdu 610041, Sichuan, China.
3 Department of Radiology, Peking Union Medical College Hospital (Dongdan campus), Beijing 100730, China.
Correspondence to: Prof. Bin Song, Department of Radiology, Sichuan University West China Hospital, No. 37, Guoxue Alley,
Chengdu 610041, Sichuan, China. E-mail: anicesong@vip.sina.com
How to cite this article: Zhang Y, Huang ZX, Chen J, Shi YJ, Jiang HY, Cao LK, Song B. Imaging biomarkers for predicting poor
prognosis of hepatocellular carcinoma: a review. Hepatoma Res 2020;6:30. http://dx.doi.org/10.20517/2394-5079.2020.17

Received: 26 Feb 2020 First Decision: 2 Apr 2020 Revised: 21 Apr 2020 Accepted: 24 Apr 2020 Published: 16 Jun 2020
Science Editor: Guido Guenther Gerken Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Hepatocellular carcinoma (HCC) is a primary malignancy of the liver with a high mortality rate. Heterogeneity
is the main biological characteristic of HCC, which manifests through the different biological behaviors of
each phenotype and ultimately, affects patient prognosis and treatment efficacy. Various aggressive biological
behaviors are considered to be associated with the poor prognosis of HCC patients including poor differentiation,
microvascular invasion, intracellular fat accumulation, invasive growth, bile duct invasion or tumor thrombosis,
and tumor spread and metastasis, and have been reported as prognostic biomarkers. In addition, HCC
results from multifactor synergistic damage, and various factors related to genetics, molecular pathology and
immunohistochemistry such as β-catenin, Ki67, cytokeratin-19, and epithelial cell adhesion molecule have an
impact on HCC differentiation and prognosis. This article is an overview of the biological behaviors that lead to
poor prognosis of HCC, and the roles of morphological and quantitative noninvasive imaging biomarkers in the
evaluation and prediction of these behaviors. Some common biomarkers related to genetics, molecular pathology
and immunohistochemistry are also briefly summarized. It is hoped that this review will provide clinicians and
radiologists with an update on the development of liver imaging, and provide directions for the combination of
radiology, genetics, molecular pathology and histopathology to better predict the prognosis of HCC patients.

Keywords: Hepatocellular carcinoma, poor prognosis, biological behaviors, imaging biomarkers, genetics, molecular
pathology, immunohistochemistry

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
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