The predictive value of preoperative ultrasound contrast parameters for early recurrence after transarterial chemoembolization for hepatocellular carcinoma.

OBJECTIVE: To analyze the predictive value of preoperative contrast-enhanced ultrasound (CEUS) parameters for early recurrence after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS: A retrospective study was conducted on 242 HCC patients treated at our hospital between May 2021 and May 2023. Based on recurrence within 24 months post-TACE, patients were categorized into an early recurrence group (N = 117) and a non-early recurrence group (N = 125). We collected baseline data and performed quantitative analysis of CEUS parameters, including time to peak (TTP), mean transit time (mTT), peak intensity (PI), and rise time (RT). A multivariable logistic regression model was used to identify risk factors for early recurrence. The predictive performance of the parameters was assessed using ROC curves, and recurrence rates were compared with Kaplan-Meier analysis. RESULTS: Significant differences were found between the two groups in alpha-fetoprotein (AFP), carbohydrate antigen 199 (CA199), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), tumor maximum diameter, and rapid washout in the portal phase (all P < 0.05). The early recurrence group had significantly lower TTP and mTT, and higher PI compared to the non-early recurrence group (all P < 0.001). No significant difference was found in RT (P > 0.05). Multivariable logistic regression analysis identified elevated AFP, CA199, GGT, and PI as independent risk factors for early recurrence, while prolonged TTP and mTT were independent protective factors (all P < 0.05). Of note, although CA19-9 is traditionally considered a biomarker for intrahepatic cholangiocarcinoma, its elevation in our strictly defined HCC cohort (pathologically confirmed or LI-RADS LR-5) may reflect aggressive tumor biology rather than inadvertent inclusion of non-HCC patients. The combined prediction model (TTP + mTT + PI) had a significantly superior AUC (0.975) for predicting early recurrence compared to any parameter alone (all P < 0.001). Internal validation using 1,000 bootstrap resamples yielded a bias-corrected AUC of 0.968 (95% CI: 0.941-0.985), confirming the model's robustness against overfitting. Patients with low TTP or low mTT had significantly higher recurrence rates, whereas those with low PI had significantly lower recurrence rates (all P < 0.001). CONCLUSION: The combined detection of the CEUS parameters TTP, mTT, and PI can effectively assist in predicting early recurrence in HCC patients after TACE.