背景：肝细胞癌（HCC）可分为增生型和非增生型，这可能与经典肝动脉化疗栓塞（cTACE）后的结果有关。在cTACE之前通常不进行活检以确定增生型HCC。目的：开发和验证一种利用CT成像特征识别增生性HCC的预测模型，并根据该模型比较cTACE后预测的增生性和非增生性HCC的治疗结果。材料和方法：这是一项回顾性多中心研究，包括2013年8月至2020年12月接受肝切除或cTACE的HCC成年患者。开发并在接受切除术的队列中外部验证了一种基于CT的识别增生型HCC的预测模型。计算了该模型的诊断性能。然后，根据该模型，将cTACE队列中的患者分为预测的增生性和非增生性HCC组。主要研究结果为总生存期（OS），次要研究结果为肿瘤反应率和无进展生存期（PFS）。使用χ2检验和log-rank检验比较了这两组之间的差异。结果：共纳入了1194名患者（1021名男性；平均年龄54岁±12 [SD]；中位随访时间29.1个月）。预测模型名为SMARS评分，包括凹凸形状、镶嵌结构、α-胎蛋白水平、环状动脉期高增强和卫星病灶。对于SMARS评分，训练队列的受试者操作特征曲线下面积为0.83，验证队列为0.80。根据SMARS评分，预测为增生型HCC的患者（n = 114）的肿瘤反应率较低（48% vs 71%；P < .001），无进展生存期（6.6个月vs 12.4个月；P < .001）和总生存期（14.4个月vs 38.7个月；P < .001）较差，与预测为非增生型HCC的患者（n = 263）相比。结论：该预测模型对于识别增生型HCC表现出良好的性能。根据SMARS评分，预测为增生型HCC的患者在cTACE后预后较差。©RSNA, 2023 本文提供了补充资料。

Background Hepatocellular carcinomas (HCCs) can be divided into proliferative and nonproliferative types, which may have implications for outcomes after conventional transarterial chemoembolization (cTACE). Biopsy to identify proliferative HCC is not routinely performed before cTACE. Purpose To develop and validate a predictive model for identifying proliferative HCCs using CT imaging features and to compare therapeutic outcomes between predicted proliferative and nonproliferative HCCs after cTACE according to this model. Materials and Methods This retrospective multicenter study included adults with HCC who underwent liver resection or cTACE between August 2013 and December 2020. A CT-based predictive model for identifying proliferative HCCs was developed and externally validated in a cohort that underwent resection. Diagnostic performance was calculated for the model. Thereafter, patients in the cTACE cohort were stratified into groups with predicted proliferative or nonproliferative HCCs according to the model. The primary outcome was overall survival (OS), and the secondary outcomes were tumor response rate and progression-free survival (PFS). These were compared between the two groups with use of the χ2 test and the log-rank test. Results A total of 1194 patients (1021 men; mean age, 54 years ± 12 [SD]; median follow-up time, 29.1 months) were included. The predictive model, named the SMARS score, incorporated lobulated shape, mosaic architecture, α-fetoprotein levels, rim arterial phase hyperenhancement, and satellite lesions. The area under the receiver operating characteristic curve for the SMARS score was 0.83 for the training cohort and 0.80 for the validation cohort. According to the SMARS score, patients with predicted proliferative HCCs (n = 114) had lower tumor response rate (48% vs 71%; P < .001) and worse PFS (6.6 months vs 12.4 months; P < .001) and OS (14.4 months vs 38.7 months; P < .001) than those with nonproliferative HCCs (n = 263). Conclusion The predictive model demonstrated good performance for identifying proliferative HCCs. According to the SMARS score, patients with predicted proliferative HCCs have worse prognosis than those with predicted nonproliferative HCCs after cTACE. © RSNA, 2023 Supplemental material is available for this article.