Preoperative Non-invasive Risk Stratification of Hepatocellular Carcinoma Based on CT

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide ( 1 Sung H. Ferlay J. Siegel R.L. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71: 209-249https://doi.org/10.3322/caac.21660 Crossref PubMed Scopus (42301) Google Scholar ). Surgical resection is one of the most effective treatment options for HCC, but recurrence after surgery remains a major clinical challenge that affects approximately 50–70% of patients within five years of surgery ( 2 Forner A. Reig M. Bruix J. Hepatocellular carcinoma. Lancet. 2018; 391: 1301-1314https://doi.org/10.1016/S0140-6736(18)30010-2 Abstract Full Text Full Text PDF PubMed Scopus (3415) Google Scholar , 3 Villanueva A. Hepatocellular carcinoma. N Engl J Med. 2019; 380: 1450-1462https://doi.org/10.1056/NEJMra1713263 Crossref PubMed Scopus (2545) Google Scholar ). There may be significant differences in recurrence and survival after hepatectomy in patients with HCC of the same stage. If patients with poor and good prognosis can be identified before surgery, then for those patients with poor prognosis, the follow-up interval can be shortened appropriately, and appropriate preventive measures can be taken, such as postoperative transarterial chemoembolization or sorafinib adjuvant therapy. On the other hand, patients with relatively good prognosis can avoid excessive treatment, reduce adjuvant therapy, and even carry out long-term follow-up without adjuvant therapy. The Korean model, Singapore Liver Cancer Recurrence score (SLICER) model, and Surgery-Specific Cancer of the Liver Italian Program (SSCLIP) model have been specifically developed to the prognosis of LR ( 4 Ang S.F. Ng E.S. Li H. et al. The Singapore Liver Cancer Recurrence (SLICER) score for relapse prediction in patients with surgically resected hepatocellular carcinoma. PLoS One. 2015. 2015; 10e0118658https://doi.org/10.1371/journal.pone.0118658 Crossref Scopus (48) Google Scholar , 5 Huang S. Huang G.Q. Zhu G.Q. et al. Establishment and validation of SSCLIP scoring system to estimate survival in hepatocellular carcinoma patients who received curative liver resection. PLoS One. 2015; 10e0129000https://doi.org/10.1371/journal.pone.0129000 Crossref Scopus (17) Google Scholar , 6 Chan A.W.H. Zhong J. Berhane S. et al. Development of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection. J Hepatol. 2018; 69: 1284-1293https://doi.org/10.1016/j.jhep.2018.08.027 Abstract Full Text Full Text PDF PubMed Scopus (279) Google Scholar ). However, due to pathological factors, such as microvascular invasion or histological grading, which can only be comprehensively evaluated on postoperative pathological sections, they are not sufficient for preoperative recurrence risk assessment. To enhance the development of clinical management strategies, including treatment plans, perioperative management, and postoperative follow-up, it is essential to establish a preoperative prognostic model. Such a model would provide valuable insights into patient prognosis prior to surgery, enabling more informed decision-making and personalized care.