Development and Validation of a Model including Arterial Enhancement Fraction to Predict the Progression in HCC Patients Undergoing Chemoembolization

Abstract Background Arterial enhancement fraction of residual tumor (AEF-RT) has been recently reported as a potential prognostic predictor for hepatocellular carcinoma (HCC) treated with drug-eluting beads transarterial chemoembolization (DEB-TACE). We aim to establish a prognostic model including AEF-RT for predicting progression-free survival (PFS) in HCC patients after DEB-TACE. Methods The Cox model for PFS was derived in a training cohort (n = 56) and tested in a temporal validation cohort (n = 55). Model performance was assessed using the concordance index (C-index) and integrated Brier score (IBS) and was compared with existing prognostic models. Results The final model, termed ADMN, incorporated A EF-RT, D iameter, M argin appearance, and N eutrophil-to-lymphocyte ratio. High-risk patients defined by ADMN had 3.92 times greater progression risk than low-risk ones in the training cohort ( p < 0.001) and 2.52 times greater in the validation cohort ( p = 0.005). The C-index of ADMN was significantly higher than that of other models in the training cohort (0.76) and remained numerically higher in the validation cohort (0.71). The ADMN model manifested the lowest IBS at 6 and 12 months in the training cohort. Although the IBS at 6 and 12 months remained at a satisfactorily low level in the validation cohort, there was no superiority of ADMN IBS over other prognostic models at 12 months. Conclusion The ADMN model enabled progression risk stratification and individualized estimation of PFS in HCC patients undergoing DEB-TACE and yielded better performance than existing models. Further external validation with a larger sample size is required.