Multimodal imaging-based prediction of recurrence for unresectable HCC after downstage and resection

Q: What clinical problem does the study address?

It targets postoperative recurrence risk prediction for patients with unresectable hepatocellular carcinoma treated with TACE-based downstaging followed by surgical resection.

Q: How are the prognostic models built and validated?

Models integrate multimodal CT, digital subtraction angiography features, and clinical/pathological factors, with XGBoost used for feature selection and Cox regression for DFS nomograms; external testing compares performance with major staging systems.

Q: Which inputs contribute to the preoperative and postoperative nomograms?

Identified factors include tumor number, intratumoral artery, use of TACE combined with tyrosine kinase inhibitors, objective response to downstaging therapy, and postoperative microvascular invasion.

Sep 21, 2026

Uploaded by Theodore

Retrospective cohort analysis evaluates how to predict postoperative recurrence risk after transarterial chemoembolization (TACE)-based downstaging followed by surgical resection in unresectable hepatocellular carcinoma (uHCC). Preoperative and postoperative prognostic models are developed and externally validated by integrating multimodal CT and digital subtraction angiography features with clinico-therapeutic-pathological factors for disease-free survival (DFS). Models are built using XGBoost feature selection and Cox regression nomograms, then tested against major staging systems and used to stratify distinct risk groups.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Background

Purpose

Materials and methods

Cohorts and data evaluation

Model development and testing

Results

Conclusion

Keywords

’Retrospective Cohort Study Multimodal imaging-based prediction of recurrence for unresectable HCC after downstage andresection-cohort study Hanyu Jiang, MDc , Mengxuan Zuo, MDa , Wang Li, MDa , Shuiqing Zhuo, MDb , Peihong Wu, MDa,*, Chao An, MDa,* Background: Surgical resection (SR) following transarterial chemoembolization (TACE)-based downstaging is a promising treatment for unresectable hepatocellular carcinoma (uHCC), and identiﬁcation of patients at high-risk of postoperative recurrence may assist individualized treatment. Purpose: To develop and externally validate preoperative and postoperative prognostic models integrating multimodal CT and digital subtraction angiography features as well as clinico-therapeutic-pathological features for predicting disease-free survival (DFS) after TACE-based downstaging therapy. Materials and methods: From March 2008 to August 2022, 488 consecutive patients with Barcelona Clinic Liver Cancer (BCLC) A/BuHCC receiving TACE-based downstaging therapy and subsequent SR were included from four tertiary-care hospitals. All CT and digital subtraction angiography images were independently evaluated by two blinded radiologists. In the derivation cohort (n = 390), the XGBoost algorithm was used for feature selection, and Cox regression analysis for developing nomograms for DFS (time from downstaging to postoperative recurrence or death) . In the external testing cohort(n = 98), model performances were compared with ﬁve major staging systems. Results: The preoperative nomogram included over three tumors [hazard ratio (HR), 1 .42; P = 0.003], intratumoral artery (HR, 1 .38; P = 0.006), TACE combined with tyrosine kinase inhibitor (HR, 0 .46; P < 0.001) and objective response to downstaging therapy (HR, 1 .60; P < 0.001); while the postoperative nomogram included over three tumors (HR, 1 .43; P = 0.013), intratumoral artery (HR, 1 .38; P = 0.020), TACE combined with tyrosine kinase inhibitor (HR, 0 .48; P < 0.001), objective response to downstaging therapy (HR, 1 .69; P < 0.001) and microvascular invasion (HR, 2 .20; P < 0.001) . The testing dataset C-indexes of the preoperative (0 .651) and postoperative (0 .687) nomograms were higher than all ﬁve staging systems (0 .472–0.542; all P < 0.001) . Two prognostically distinct risk strata were identiﬁed according to these nomograms (all P < 0.001) . Conclusion: Based on 488 patients receiving TACE-based downstaging therapy and subsequent SR for BCLC A/B uHCCs, the authors developed and externally validated two nomograms for predicting DFS, with superior performances than ﬁve major staging systems and effective survival stratiﬁcation. Keywords: downstaging therapy, hepatocellular carcinoma, multimodal imaging, prognosis, surgical resection Introduction Primary liver cancer is the sixth most common malignancy and third leading cause of cancer-related death worldwide, and hepatocellular carcinoma (HCC) accounts for 75–86% of these cases[1–4] . However, over 70% of HCCs are diagnosed at the intermediate to advanced stages[5] . Recently, growing data suggest the use of transarterial chemoembolization (TACE), as aDepartment of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, bDepartment of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yatsen University Cancer Center, Guangzhou, Guangdong and cDepartment of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People ’s Republic of China Hanyu Jiang and Mengxuan Zuo contributed equally to this manuscript. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding authors. Address: State Key Laboratory of Oncology in South China, Guan

FAQs

What clinical problem does the study address?

It targets postoperative recurrence risk prediction for patients with unresectable hepatocellular carcinoma treated with TACE-based downstaging followed by surgical resection.

How are the prognostic models built and validated?

Models integrate multimodal CT, digital subtraction angiography features, and clinical/pathological factors, with XGBoost used for feature selection and Cox regression for DFS nomograms; external testing compares performance with major staging systems.

Which inputs contribute to the preoperative and postoperative nomograms?

Identified factors include tumor number, intratumoral artery, use of TACE combined with tyrosine kinase inhibitors, objective response to downstaging therapy, and postoperative microvascular invasion.

Sep 21, 2026

Uploaded by Theodore