Page 83 - Read Online

Page 14 of 22 Ma et al. Hepatoma Res. 2026;12:43

Alpha-fetoprotein, BCLC, Child-Pugh and Response score
The Alpha-fetoprotein, BCLC, Child-Pugh and Response (ABCR) score is a new prognostic score based on
[53]
the limitations of the ART/mART score. It is used to evaluate the prognosis of patients before the second
TACE to help clinicians decide whether to continue TACE treatment. The core variables of the ABCR score
include 4: serum AFP level at baseline (≥ 200 ng/mL, +1 point), BCLC stage (stage B: +2 points, stage C: +3
points), the difference between the Child-Pugh grade before the second operation and the baseline Child-
Pugh grade (score increase ≥ 2 points: +2 points), tumor reactivity (no response: -3 points, response: 0
points). The patients were divided into three groups according to the total score: ABCR score ≤ 0 (median
survival > 34 months), ABCR score 1-3 (median survival of approximately 12-17 months), and ABCR score ≥
4 (median survival <​ 8 months). The results suggest that patients with ABCR ≥ 4 have a very poor prognosis
and may no longer be suitable for continuing TACE. The ABCR score is a simple and reproducible
prognostic tool suitable for decision-making before second TACE. The score combines baseline
characteristics (BCLC and AFP) and treatment response (imaging and liver function), making it more
clinically relevant. However, this score also has limitations. The included BCLC stage C patients were
restricted to those with segmental portal vein tumor thrombus (PVTT) and arterial enhancement on
imaging. Thus, the score is not applicable to all BCLC stage C patients, particularly those with main PVTT,
extrahepatic metastasis, or poorer performance status.

Cascade survival map
The cascade survival path map was developed by Shen et al. based on time series to dynamically predict the
prognosis of HCC patients receiving comprehensive treatment . The model includes BCLC stage B patients
[54]
from multiple centers, converts clinical data at multiple time points during follow-up into time slices with a
3-month interval, and selects the most prognostic variables for path bifurcation through Cox regression at
each time slice to construct a visual survival path map. Finally, 13 different survival paths were constructed in
the derivation cohort using recursive segmentation. The results showed that the model showed better or
equal prognostic discrimination ability (C-index 0.733-0.830) than the BCLC, American Joint Committee on
Cancer (AJCC) staging system, and ART score in time slices 3 to 9. In the test cohorts, its advantage in
predicting survival was validated in the early time slices. This model can not only dynamically predict
survival but also identify “opportunity nodes”. Active treatment at this time point can greatly improve
survival. The survival path system model is an innovative dynamic prognostic tool, which systematically
converts time-series data into a dynamic path map. It shows great potential in dealing with clinical time
series big data and provides a new idea for the development of cancer prognostic models. However, this
model has limitations: (1) Predictive ability declines in later stages due to reduced sample size, diminishing
the dynamic advantage; (2) Fixed time slices and variable dichotomization lead to loss of precise data; (3)
Generalizability requires further validation; (4) Machine learning could be introduced to optimize feature
selection.

Post-TACE-predict model
Post-TACE-Predict is an extension of Pre-TACE-Predict that incorporates imaging response after the first
[48]
TACE (assessed by mRECIST) to provide dynamic prognostic reassessment. The model includes six
variables: tumor number, tumor size (log ), AFP (log ), bilirubin (log ), vascular invasion, and mRECIST
10
10
10
response (CR as reference). Based on the linear predictor, patients are stratified into four risk categories
using the 16th, 50th, and 84th percentiles as cut-offs, with mOS as follows: low-risk approximately 51-56
months, medium-low risk approximately 27-34 months, medium-high risk approximately 18-22 months,
and high-risk approximately 7-10 months. A free online calculator (TACE-Predict) is available; users input
baseline parameters plus mRECIST response to obtain updated prognostic predictions. The core value of
Post-TACE-Predict lies in its dynamic prognostic evaluation, recalibrating patient prognosis based on