Machine learning based hepatic safety score predicts decompensation in hepatocellular carcinoma systemic therapy.

Authors

Ji Won Han, Jaejun Lee, Keungmo Yang, Kwon Yong Tak, Hyun Yang, Si Hyun Bae, Hee Sun Cho, Heechul Nam, Chang Wook Kim, Hae Lim Lee, Hee Yeon Kim, Sung Won Lee, Ahlim Lee, Do Seon Song, Seok Hwan Kim, Myeong Jun Song, Soon Woo Nam, Soon Kyu Lee, Jung Hyun Kwon, Pil Soo Sung, Jeong Won Jang

Published in

NPJ digital medicine. May 22, 2026. Epub May 22, 2026.

Abstract

Hepatocellular carcinoma (HCC) frequently coexists with portal hypertension, significantly increasing the risk of hepatic decompensation (HD) and variceal bleeding during systemic therapy. We developed a machine learning based hepatic safety score (MHSS) using data from 2026 patients with unresectable HCC to predict clinically significant portal hypertension (CSPH) and prognosis. A random forest model was trained in a derivation cohort (n = 1262) and validated in an independent cohort (n = 764). The MHSS demonstrated robust performance (AUROC 0.840) in CSPH and predicting HD. Stratification revealed that high MHSS patients faced significantly elevated risks of HD (HR 3.25), variceal bleeding (VB, HR 4.90), and mortality (HR 2.21). Crucially, while atezolizumab-bevacizumab offered a survival advantage in low MHSS patients, it was associated with high bleeding risk and no survival benefit in the high MHSS group compared to other regimens. A simulation of MHSS guided treatment selection demonstrated a 24% reduction in HD, a 40% reduction in VB, and a 26% reduction in mortality. In conclusion, the MHSS effectively predicts CSPH, decompensation, and survival in patients with HCC prior to systemic therapy. By enabling individualized risk stratification, the MHSS may guide personalized treatment selection between bevacizumab-containing and alternative regimens, ultimately improving patient outcomes. Clinical trial number: not applicable.

PMID:
42168526
Bibliographic data and abstract were imported from PubMed on 22 May 2026.

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