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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.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/multimodal-imaging-based-prediction-of-recurrence-for-unresectable-hcc-after-downstage-and-resection/333763/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/multimodal-imaging-based-prediction-of-recurrence-for-unresectable-hcc-after-downstage-and-resection/333763.png","ImageObject",300,407,{"name":92,"@type":93},"Theodore","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical problem does the study address?","Question",{"text":113,"@type":114},"It targets postoperative recurrence risk prediction for patients with unresectable hepatocellular carcinoma treated with TACE-based downstaging followed by surgical resection.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How are the prognostic models built and validated?",{"text":118,"@type":114},"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.",{"name":120,"@type":111,"acceptedAnswer":121},"Which inputs contribute to the preoperative and postoperative nomograms?",{"text":122,"@type":114},"Identified factors include tumor number, intratumoral artery, use of TACE combined with tyrosine kinase inhibitors, objective response to downstaging therapy, and postoperative microvascular invasion.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},333763,1790012967,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":105,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","’Retrospective Cohort Study  \nMultimodal imaging-based prediction of recurrence for unresectable HCC after downstage andresection-cohort study  \nHanyu Jiang, MDc , Mengxuan Zuo, MDa , Wang Li, MDa , Shuiqing Zhuo, MDb , Peihong Wu, MDa,*, Chao An, MDa,*  \nBackground: 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.  \nPurpose: 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.  \nMaterials 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 \u003C 0.001) and objective response to downstaging therapy (HR, 1 .60; P \u003C 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 \u003C 0.001), objective response to downstaging therapy (HR, 1 .69; P \u003C 0.001) and microvascular invasion (HR, 2 .20; P \u003C 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 \u003C 0.001) . Two prognostically distinct risk strata were identified according to these nomograms (all P \u003C 0.001) .  \nConclusion: 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.  \nKeywords: downstaging therapy, hepatocellular carcinoma, multimodal imaging, prognosis, surgical resection  \nIntroduction  \nPrimary liver cancer is the sixth most common malignancy and third leading cause of cancer-related death worldwide, and  \nhepatocellular 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  \naDepartment 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  \nHospital, Sichuan University, Chengdu, Sichuan, People ’s Republic of China Hanyu Jiang and Mengxuan Zuo contributed equally to this manuscript.  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding authors. Address: State Key Laboratory of Oncology in South China, Guan","cbCaiaWGgSSwaOuJ","https://ap.wps.com/l/cbCaiaWGgSSwaOuJ","pdf",1573020,"English","# Background\n# Purpose\n# Materials and methods\n## Cohorts and data evaluation\n## Model development and testing\n# Results\n# Conclusion\n# Keywords","[{\"question\":\"What clinical problem does the study address?\",\"answer\":\"It targets postoperative recurrence risk prediction for patients with unresectable hepatocellular carcinoma treated with TACE-based downstaging followed by surgical resection.\"},{\"question\":\"How are the prognostic models built and validated?\",\"answer\":\"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.\"},{\"question\":\"Which inputs contribute to the preoperative and postoperative nomograms?\",\"answer\":\"Identified factors include tumor number, intratumoral artery, use of TACE combined with tyrosine kinase inhibitors, objective response to downstaging therapy, and postoperative microvascular invasion.\"}]","Multimodal imaging-based prediction of recurrence for unresectable HCC after downstage and resection | PDF",1790003935,33]