IMAT-HCC model: Liver stiffness-enhanced integrated risk stratification for HCC recurrence after resection

Area of Science:

• Hepatobiliary surgery
• Hepatocellular carcinoma (HCC) research
• Adjuvant therapy trials

Background:

• Adjuvant immunotherapy (atezolizumab plus bevacizumab) for hepatocellular carcinoma (HCC) shows waning benefit.
• Inadequate patient selection may limit adjuvant therapy efficacy.
• External validation of IMbrave050 trial criteria and integration of liver stiffness measurement (LSM) are needed for improved risk stratification.

Purpose of the Study:

• To externally validate IMbrave050 trial high-risk criteria for HCC recurrence.
• To investigate if integrating LSM improves recurrence risk stratification post-resection.
• To develop a pragmatic framework for future adjuvant HCC trial enrollment.

Main Methods:

• Retrospective analysis of 147 patients undergoing curative HCC resection (2010-2020).
• Defined high-risk status using IMbrave050 criteria; LSM assessed preoperatively.
• Utilized competing-risk analyses (Fine-Gray) and Net Reclassification Improvement (NRI) to evaluate LSM's added value.

Main Results:

• High-risk IMbrave050 features and LSM ≥ 15 kPa independently predicted recurrence.
• Patients with IMbrave050-OUT status but LSM ≥ 15 kPa had recurrence rates similar to IMbrave050-IN patients.
• The integrated IMAT-HCC rule (IMbrave050 criteria + LSM) improved patient reclassification (NRI 8.0%) and risk stratification.

Conclusions:

• Integrating LSM with tumor-based criteria refines identification of high-risk HCC patients post-resection.
• The IMAT-HCC rule offers a simple, non-invasive method for enhancing adjuvant trial enrichment strategies.
• This approach improves risk stratification and patient selection, addressing limitations of solely tumor-centric criteria.