Radiomics Subtyping to Guide Surgery vs. Maintenance Therapy After HCC Downstaging

Inclusion Criteria:

1. Patients diagnosed with hepatocellular carcinoma (HCC) based on clinical or pathological criteria;
2. Barcelona Clinic Liver Cancer (BCLC) stage B or C, assessed as unresectable by surgical evaluation; Underwent treatment with TACE combined with lenvatinib and a PD-1 inhibitor, after which the tumor was re-evaluated and deemed resectable by surgical assessment;
3. Following the achievement of surgical resectability criteria, patients subsequently underwent either R0 surgical resection or continued treatment with TACE combined with lenvatinib and a PD-1 inhibitor;
4. Liver function classified as Child-Pugh Class A or B, or achieved this standard after medical treatment;
5. Performance status (PS) score of 0 or 1.

Exclusion Criteria:

1. Patients with unclear diagnoses or those with concurrent other malignancies.
2. For patients in the downstaging surgery group: Those who underwent non-R0 resection or received additional anti-tumor therapies postoperatively.
3. For patients in the maintenance treatment group: Those who received anti-tumor therapies other than TACE/lenvatinib/PD-1 inhibitors.
4. Liver function classified as Child-Pugh Class C or above, unresponsive to hepatoprotective therapy.
5. Patients with severe infections, such as respiratory, biliary tract, or abdominal infections.
6. Patients with severe underlying diseases, particularly immune-related disorders.