MRI-based predictive model with obesity metabolic phenotype for postoperative survival in HBV-related hepatocellular carcinoma.

[PURPOSE] Obesity metabolic phenotypes may influence survival outcomes in hepatocellular carcinoma (HCC) patients. This study aimed to develop an MRI-based model for postoperative survival prediction in HBV-related HCC patients, focusing on obesity metabolic phenotypes.

[METHODS] A retrospective cohort of 381 HBV-related HCC patients (312 males; mean age 55.9 ± 10.7 years) who underwent preoperative MRI and curative surgery was studied. Patients were categorized into three phenotypes: normal weight (NW), metabolically healthy overweight/obesity (MHOO) and metabolically unhealthy overweight/obesity (MUOO). Univariate and multivariate Cox regression analyses identified independent predictors of overall survival (OS). A predictive model was established and validated with cross-validation.

[RESULTS] MHOO patients showed significantly better overall survival (OS) than NW patients (adjusted HR = 0.42, P = 0.030), while MUOO had no significant effect on OS (adjusted HR = 0.92, P = 0.779). Independent predictors included MHOO (HR = 0.44, P = 0.036), AST/ALT ratio > 1 (HR = 2.61, P = 0.001), tumor burden score > 5.0 (HR = 3.02, P < 0.001) and arterial rim enhancement (HR = 3.61, P < 0.001). The combined model achieved good performance in both training (C-index = 0.737) and validation (C-index = 0.715) sets. The predicted high-risk patients had worse OS than low-risk patients in the whole cohort (P < 0.001) and in patients at BCLC stage A (P < 0.001). The model outperformed the BCLC and CNLC staging systems in predictive efficacy (all P < 0.001) and clinical net benefit.

[CONCLUSIONS] MHOO is protective for OS in HBV-related HCC. The MRI-based model integrating obesity metabolic phenotype, AST/ALT ratio, tumor burden score and arterial rim enhancement is valuable in survival prediction, offering superior prognostic stratification compared to current staging systems.