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Page 18 of 22 Ma et al. Hepatoma Res. 2026;12:43

but also reduces the required number of TACE procedures, thereby mitigating cumulative liver injury and
overcoming TACE refractoriness; (3) Static to individual evolution: Traditional staging systems evaluate
patients at a single time point and do not adapt to disease progression or treatment response. Future
management should incorporate dynamic prediction models that integrate treatment response, longitudinal
biomarker changes, and real-time clinical data to guide individualized decisions on whether to continue,
switch, or discontinue TACE. The development of novel embolic materials, such as Zein-based systems [57]
and magnesium microsphere embolic agents , is expected to enable more precise and durable vascular
[58]
occlusion while alleviating post-embolization hypoxia and hepatic function impairment. Moreover, the
integration of TACE with systemic therapies (such as “TACE + camrelizumab + apatinib”, “TACE +
durvalumab + tremelimumab”) may further enhance tumor response and reduce the need for repeated
TACE sessions, thereby preserving liver function and improving survival outcomes. Beyond radiomics and
circulating biomarkers, pathomics, the high-throughput extraction of quantitative features from digitized
pathological images, has emerged as a promising avenue for prognosis prediction in HCC patients receiving
TACE . Pathomics enables the characterization of tumor morphology, cellular architecture, and spatial
[59]
heterogeneity at the histopathological level, complementing the information obtained from medical imaging
and liquid biopsy . Recent studies have demonstrated that pathomics features, particularly those related to
[60]
tumor-infiltrating lymphocytes and stromal organization, are associated with treatment response and
survival outcomes in HCC . Furthermore, the integration of pathomics with transcriptomic data (e.g.,
[61]
transcription factor signatures) has shown potential for predicting TACE refractoriness and characterizing
the tumor microenvironment. However, it should be noted that pathomics research specifically focused on
TACE-treated HCC patients remains limited compared with radiomics and genomics. Future studies are
warranted to establish standardized pathomics workflows and validate their incremental value when
combined with clinical, radiomic, and circulating biomarker-based models. This multi-dimensional
integration, encompassing pathomics, radiomics, genomics, and clinical parameters, represents a promising
direction toward truly individualized prognosis prediction for HCC patients undergoing TACE .
[59]
Correspondingly, the future prediction model is no longer a single calculation formula but an intelligent
system integrating multidimensional data, continuous learning, and dynamic updating. We look forward to
more prospective multicenter studies to verify the clinical applicability of the new prediction model. At the
same time, with the transformation of BCLC and other staging systems to the “treatment path” mode, and
the deep integration of artificial intelligence and real-world data, TACE treatment of HCC is bound to enter
a new era of more precision, individualization, and dynamic optimization.

DECLARATIONS
Acknowledgments
The Graphical Abstract was created with figdraw.com [Created in figdraw. Ma, Y. (2025) ID:
AOOOWb4be4].

Authors’ contributions
Writing the manuscript, visualization, conceptualization: Ma YY, Chen L, Zhu HD
Creating and revising the tables and figures: Ma YY, Li CH
Conceptualization, supervision, project administration, funding acquisition, writing-review and editing: Zhu
HD, Li YY, Li GJ, Chen L
All authors read and approved the final manuscript.

Availability of data and materials
Not applicable.

AI and AI-assisted tools statement
During the preparation of this manuscript, the AI tool DeepSeek (DeepSeek-V3, released 2025-12-26) was
used solely for language editing and grammar refinement. The tool did not influence the study design, data
collection, analysis, interpretation, or the scientific content of the work. All authors take full responsibility