Objective:

To evaluate prognostic determinants and develop a prediction model for overall survival in primary liver cancer patients treated with TACE, highlighting its clinical significance.

Key Findings:

• Among 185 patients, median OS was 28.0 months, and median PFS was 10.9 months. These findings suggest significant variability in patient outcomes post-TACE.
• Independent predictors of worse OS included maximum tumor diameter, portal vein tumor thrombosis, extrahepatic metastasis, Child–Pugh class B, INR, and alpha-fetoprotein, indicating critical factors for risk assessment.
• The model showed good discrimination with a C-index of 0.812 for training and 0.791 for validation, suggesting its potential utility in clinical settings.

Interpretation:

A Cox-based model integrating tumor burden, disease extent, hepatic reserve, coagulation status, and tumor biology provides individualized OS risk stratification after TACE, which can guide treatment decisions.

Limitations:

• The study is retrospective and may be subject to selection bias.
• Findings may not be generalizable to all populations due to the specific cohort studied.
• Potential confounding factors related to treatment history and patient selection were not fully addressed.

Conclusion:

The study presents a prognostic model that can aid in individualized risk assessment for patients undergoing TACE for primary liver cancer.