Abstract: To evaluate the value of imaging tumor burden score (TBS) combined with serum alpha-fetoprotein (AFP) in the prognosis of hepatocellular carcinoma (HCC) after transarterial chemo-embolization (TACE). Clinical and imaging data of 87 HCC patients who underwent TACE were collected. The TBS scores were calculated from CT-enhanced images. OS was compared between groups using Kaplan-Meier survival curves and log-rank test. The median survival of HCC patients after TACE was 20.5 months, and the mean TBS score was 9.52±3.26. The results showed that the 3-year OS decreased progressively with increasing TBS (P<0.001); the difference in OS between patients with TBS ≤ 9.9 and TBS>9.9 was statistically significant (P<0.001). Patients' pre-TACE AFP levels were moderately negatively correlated with OS (r=-0.519; P<0.001), and OS was worse in patients with AFP ≥ 400 ng/mL compared with those with AFP < 400 ng/mL (P=0.001). Multifactorial analysis showed that patients with TBS ≤ 9.9 and AFP ≥ 400 ng/mL (HR:5.449; 95%CI:1.951-15.217; P=0.01), TBS>9.9 and AFP<400 ng/mL (HR:13.576; 95%CI:5.873-31.382; P<0.001) and TBS>9.9 and AFP ≥ 400 ng/mL (HR:27.854; 95%CI:8.950-86.683; P<0.001) were both independent predictors of OS after TACE in patients with hepatocellular carcinoma, and the OS of patients with TBS ≤ 9.9 and AFP<400 ng/mL was better than the other three groups (P<0.05). Therefore, the image-based TBS score combined with AFP level has a high value in the prognosis assessment of HCC patients with TACE.

Key words: hepatocellular carcinoma, transarterial chemo-embolization, tumor burden score, alpha-fetoprotein