OBJECTIVES Models should be developed to assist choice between liver resection (LR) and transarterial chemoembolization (TACE) for hepatocellular carcinoma. METHODS After separating 520 cases from 5 hospitals into training (n = 302) and validation (n = 218) data sets, we weighted the cases to control baseline difference and ensured the causal effect between treatments (LR and TACE) and estimated progression-free survival (PFS) difference. A noninvasive PFS model was constructed with clinical factors, radiological characteristics, and radiomic features. We compared our model with other 4 state-of-the-art models. Finally, patients were classified into subgroups with and without significant PFS difference between treatments. RESULTS Our model included treatments, age, sex, modified Barcelona Clinic Liver Cancer stage, fusion lesions, hepatocellular carcinoma capsule, and 3 radiomic features, with good discrimination and calibrations (area under the curve for 3-year PFS was 0.80 in the training data set and 0.75 in the validation data set; similar results were achieved in 1- and 2-year PFS). The model had better accuracy than the other 4 models. A nomogram was built, with different scores assigned for LR and TACE. Separated by the threshold of score difference between treatments, for some patients, LR provided longer PFS and might be the better option (training: hazard ratio [HR] = 0.50, P = 0.014; validation: HR = 0.52, P = 0.026); in the others, LR provided similar PFS with TACE (training: HR = 0.84, P = 0.388; validation: HR = 1.14, P = 0.614). TACE may be better because it was less invasive. DISCUSSION We propose an individualized model predicting PFS difference between LR and TACE to assist in the optimal treatment choice.

中文翻译：

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肝切除与肝动脉化疗栓塞之间的选择：一项多中心研究。

目的应建立模型以协助选择肝癌肝切除术（LR）和经动脉化学栓塞术（TACE）。方法将5所医院的520例病例分为训练（n = 302）和验证（n = 218）数据集后，我们对病例进行加权以控制基线差异，并确保治疗（LR和TACE）之间的因果关系和估计的无进展生存（PFS）差异。构建具有临床因素，放射学特征和放射学特征的非侵入性PFS模型。我们将模型与其他4个最新模型进行了比较。最后，将患者分为治疗之间和不存在明显PFS差异的亚组。结果我们的模型包括治疗，年龄，性别，改良的巴塞罗那临床肝癌分期，融合病变，肝细胞癌胶囊和3个放射学特征，具有良好的辨别力和校正度（3年PFS曲线下的面积在训练数据集中为0.80，在验证数据集中为0.75;在1年和2年中获得了类似的结果PFS）。该模型比其他4个模型具有更好的准确性。建立了列线图，为LR和TACE分配了不同的分数。除了治疗之间的评分差异阈值，对于某些患者，LR提供更长的PFS，可能是更好的选择（培训：危险比[HR] = 0.50，P = 0.014；验证：HR = 0.52，P = 0.026）；在其他情况下，LR提供了与TACE类似的PFS（训练：HR = 0.84，P = 0.388；验证：HR = 1.14，P = 0.614）。TACE可能会更好，因为它的侵入性较小。