Fully automated spleen segmentation predicts progression-free survival in HCC patients following transarterial radioembolization

PURPOSE: Transarterial radioembolization (TARE) is a well-established treatment for unresectable hepatocellular carcinoma (HCC), though its effects on non-tumorous tissue remain a concern. In particular, the prognostic relevance of splenic volume changes after TARE is not fully understood. This study aimed to assess imaging-derived markers-specifically splenic volume dynamics-as predictors of disease progression. METHODS: Y) at our institution between January 2012 and September 2022. Inclusion criteria were age ≥ 18 years, availability of baseline and 3-month follow-up imaging, and complete clinical documentation. Patients undergoing liver resection, transplantation, or additional therapies during follow-up were excluded. RESULTS: A relative increase in splenic volume at 3 months was the only independent predictor of progression-free survival (PFS), yielding a ROC-AUC of 0.86 (95%-CI: 0.76-0.95). An increase of 18% or more most accurately identified patients with early disease progression (< 12 months) with a sensitivity 0.74 and specificity 0.97, outperforming conventional clinical and laboratory parameters, including two-dimensional craniocaudal spleen measurements. CONCLUSIONS: Automated splenic volumetry showed superior prognostic value over traditional markers in HCC patients treated with TARE. A post-treatment increase in spleen volume represents an additional, robust, and readily accessible imaging biomarker for early risk stratification and individualized treatment planning.