Multimodal Deep Learning for Postoperative Liver Cancer Risk Stratification and Intervention

Inclusion criteria

• Age and Consent: Patients aged 18-75 years who are able to understand and voluntarily sign an Informed Consent Form.
• Diagnosis: Clinical diagnosis of BCLC stage 0-A hepatocellular carcinoma, confirmed by histopathology or non-invasive imaging criteria per guidelines.
• Surgical Candidacy: Scheduled to undergo curative-intent liver resection.
• Risk Stratification: Predicted as high-risk for aggressive recurrence by the pre-operative multimodal deep learning model (PRE score ≥ 0.5).
• Liver Function: Child-Pugh liver function class A (score ≤ 7).
• Performance Status: ECOG Performance Status of 0 or 1.
• Imaging Requirement: Availability of a standard pre-operative MRI scan (including non-contrast, arterial, portal venous, and delayed phases) performed within 1 month prior to enrollment, with acceptable image quality.
• Follow-up Commitment: Willing and able to comply with the study procedures and scheduled follow-up for at least 2 years.

Exclusion criteria

• Pathology: Postoperative pathological confirmation of non-HCC malignancy (e.g., cholangiocarcinoma, combined hepatocellular-cholangiocarcinoma).
• Other Malignancies: History of other active malignancies within the past 5 years, except for appropriately treated carcinoma in situ of the cervix, non-melanoma skin cancer, or other cancers with a very low risk of recurrence.
• Early Mortality/Loss: Death from any cause or loss to follow-up within 90 days after surgery.
• Contraindications to Protocol Therapy: Known hypersensitivity to any component of the neoadjuvant therapy regimen (e.g., oxaliplatin, fluorouracil, PD-1 inhibitors, lenvatinib).
• Severe, uncontrolled medical conditions including but not limited to: Uncontrolled cardiac disease (e.g., NYHA Class III or IV heart failure), Severe renal dysfunction, Uncontrolled hypertension.
• Inability to Participate: Any condition that, in the opinion of the investigator, would compromise the patient's ability to participate in the study or interfere with the evaluation of the study objectives.