Marginal Contrast Saturation‐Based Intraoperative Scoring System Predicts Objective Response to
DEB
‐
TACE
: Development and Validation of a
Zhongsong Gao, Bo Li, Bo Feng, Cheng Sun, Ying Zang, Xin Zhang, Yongmei Wang, Qi Xin, Kefeng Jia, Rong Lyu ABSTRACT
Objective
To develop and validate a simple intraoperative scoring system based on preoperative and cone‐beam CT (CBCT) features for real‐time prediction of objective response (OR) by mRECIST after DEB‐TACE in patients with HCC.
Materials and Methods
In this single‐center retrospective study, 274 patients (with a total of 386 HCC tumors) who underwent first‐session DEB‐TACE from 2022 to 2024 were included. CBCT was used to assess a 5‐grade marginal contrast saturation (MCS), capsule presence, vascular lake phenomenon (VLP), and other candidate imaging features. Tumor response was assessed on contrast‐enhanced CT using mRECIST. Analyses were performed on a tumor basis, with tumors assigned to development ( n = 286) and validation ( n = 100) sets by patient‐level stratified randomization (7:3). Variables associated with OR were entered into a multivariable logistic regression; β coefficients were converted into a point‐based score. Model performance was evaluated in terms of discrimination and calibration using the AUROC and the Hosmer–Lemeshow test.
Results
Most patients were male (78.8%), with a mean age of 62.5 ± 9.4 years. The median tumor diameter was 3.75 cm (interquartile range [IQR], 2.50–6.50 cm). The overall objective response rate (ORR) was 67.9% (262/386). Multivariable analysis revealed four independent predictors of OR: tumor diameter, capsule presence, VLP, and MCS grade. A 1–10‐point score achieved excellent discrimination in the development set and maintained high performance in the validation set, with an AUROC of 0.93 (95% confidence interval [CI]: 0.86–0.99, goodness‐of‐fit p = 0.46).
Conclusion
An imaging‐only, intraoperative scoring system incorporating tumor size, capsule, VLP, and MCS accurately predicts short‐term mRECIST response after DEB‐TACE, facilitating rapid decision‐making and subsequent patient management.