Preoperative estimation of the survival of patients with unresectable hepatocellular carcinoma achieving complete response after conventional transcatheter arterial chemoembolization: assessments of clinical and LI-RADS MR features

To identify the associations of clinical and magnetic resonance (MR) features with overall survival (OS) in patients with unresectable hepatocellular carcinoma (HCC) achieving complete response (CR) after conventional transcatheter arterial chemoembolization (TACE) and to further develop an individual nomograph to estimate the survival probability.A total of 112 patients with unresectable HCC treated with TACE as first-line treatment were retrospectively evaluated. Potential risk factors associated with OS were identified by univariate and multivariate Cox analyses. The survival model was developed by multivariate Cox proportional hazard model. The area under the receiver operating characteristic curve was calculated to assess the performance of each marker and of the whole model. Discrimination was performed using Kaplan-Meier curves, and the survival curves were compared by the log-rank test. A nomogram derived from the survival model was established.Multivariate Cox analyses indicated that nonsmooth tumor margin, peritumoral enhancement, fat sparing in solid mass, and Barcelona clinic liver cancer (BCLC) stage were independent risk indicators associated with OS. The survival model showed acceptable diagnostic power, with an area under the curve (AUC) of 0.687. Kaplan-Meier curves demonstrated that the model discriminated well, as the high-risk and low-risk groups had median survival times of 21.6 months and 34.8 months, respectively (log-rank test, P = 0.01).Nonsmooth tumor margin, peritumoral enhancement, fat sparing in solid mass, and BCLC stage were potential biomarkers to evaluate the survival with favorable performance and discriminate HCC patients with CR under conventional TACE treatment.