Radiomics, a field that extracts quantitative features from medical images, plays a crucial role in predicting the efficacy of treatments like Transcatheter Arterial Chemoembolization (TACE) for hepatocellular carcinoma (HCC). Recent advancements have shown that combining radiomics with clinical and genetic data enhances predictive accuracy. This integration has significantly influenced current diagnostic and treatment strategies for HCC. Studies have demonstrated that these combined models provide more precise predictions, leading to improved patient outcomes. This review summarizes recent advances and current challenges in radiomics-based combined models for predicting outcomes after TACE in HCC. It systematically outlines key breakthroughs, including multimodal data fusion, improved methods for quantifying intratumoral heterogeneity, and enhanced model predictive performance. It also examines persistent bottlenecks: dataset-dependent feature standardization, limited model generalizability, clinical annotation bias, and high computational costs. The goal of this review was to guide researchers in addressing these technical barriers and optimizing model architectures, to provide evidence for individualized clinical decision-making, and to accelerate the translation of radiomics combined models from basic research into standardized clinical practice—ultimately improving post-TACE outcomes and long-term quality of life for HCC patients.
Zhang C, Cheng Y, Zhang S, et al., 2022, Changing Epidemiology of Hepatocellular Carcinoma in Asia. Liver International, 42(9): 2029–2041.
Zhou J, Sun H, Wang Z, et al., 2025, China Liver Cancer Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2024 Edition). Liver Cancer, 1: 1–57.
Song P, Tang W, Kokudo N, 2024, Expert Consensus on Sequential Surgery After Immune-Targeted Conversion Therapy for Advanced Hepatocellular Carcinoma in China. BioScience Trends, 18(6): 495–496.
Deng K, Chen T, Leng Z, et al., 2024, Radiomics as a Tool for Prognostic Prediction in Transarterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. La Radiologia Medica, 129(8): 1099–1117.
Zhang M, Wang Y, Tang X, et al., 2025, Mineralized Supramolecular Microspheres with Immunoregulating Functions for Transarterial Chemoembolization Immunotherapy of Hepatocellular Carcinoma. Small Methods, 9(12): e00857.
Chen Y, Hu Y, Shen J, et al., 2025, External Beam Radiation Therapy After Transarterial Chemoembolization Versus Transarterial Chemoembolization Alone for Treatment of Inoperable Hepatocellular Carcinoma: A Randomized Phase 3 Trial. International Journal of Radiation Oncology Biology Physics, 121(2): 414–422.
Jiang C, Cai YQ, Yang JJ, et al., 2023, Radiomics in the Diagnosis and Treatment of Hepatocellular Carcinoma. Hepatobiliary & Pancreatic Diseases International, 22(4): 346–351.
Miranda J, Horvat N, Fonseca GM, et al., 2023, Current Status and Future Perspectives of Radiomics in Hepatocellular Carcinoma. World Journal of Gastroenterology, 29(1): 43–60.
Shi Y, Zhang P, Li L, et al., 2025, Interpretable Model Based on Multisequence Magnetic Resonance Imaging Radiomics for Predicting the Pathological Grades of Hepatocellular Carcinomas. World Journal of Radiology, 17(12): 112911.
Liu C, Han L, Ding X, et al., 2025, Development of a Predictive Model for Distant Metastasis in HCC Patients Post-TACE Using Clinical Data, Radiomics, and Deep Learning. Journal of Cancer Research and Clinical Oncology, 151(10): 1–15.
Xia TY, Zhou ZH, Meng XP, et al., 2023, Predicting Microvascular Invasion in Hepatocellular Carcinoma Using CT-Based Radiomics Model. Radiology, 307(4): e222729.
Bo Z, Song J, He Q, et al., 2024, Application of Artificial Intelligence Radiomics in the Diagnosis, Treatment, and Prognosis of Hepatocellular Carcinoma. Computers in Biology and Medicine, 173: 108337.
Li ZC, Wang J, Liu HB, et al., 2024, Proteomic and Metabolomic Features in Patients with HCC Responding to Lenvatinib and Anti-PD1 Therapy. Cell Reports, 43(3): 113877.
Zhang W, Guo Q, Zhu Y, et al., 2024, Cross-Institutional Evaluation of Deep Learning and Radiomics Models in Predicting Microvascular Invasion in Hepatocellular Carcinoma: Validity, Robustness, and Ultrasound Modality Efficacy Comparison. Cancer Imaging, 24(1): 1–10.
Li H, Shen X, Wu J, 2025, Predicting Preoperative Risk and Prognosis in Patients with Proliferative Hepatocellular Carcinoma. Academic Radiology, 32(3): 1777–1778.
Lin Z, Wang W, Yan Y, et al., 2025, A Deep Learning-Based Clinical-Radiomics Model Predicting the Treatment Response of Immune Checkpoint Inhibitors (ICIs)-Based Conversion Therapy in Potentially Convertible Hepatocellular Carcinoma Patients: A Tumor Marker Prognostic Study. International Journal of Surgery, 111(5): 3342–3355.
Hapaer G, Che F, Xu Q, et al., 2025, Radiomics-Based Biomarker for PD-1 Status and Prognosis Analysis in Patients with HCC. Frontiers in Immunology, 16: 1435668.
Xia D, Bai W, Wang Q, et al., 2025, Tumor Burden with AFP Improves Survival Prediction for TACE-Treated Patients with HCC: An International Observational Study. JHEP Reports, 7(1): 101216.
Bo Z, Chen B, Zhao Z, et al., 2023, Prediction of Response to Lenvatinib Monotherapy for Unresectable Hepatocellular Carcinoma by Machine Learning Radiomics: A Multicenter Cohort Study. Clinical Cancer Research, 29(9): 1730–1740.
Cao ZC, He KW, Wang YQ, et al., 2024, 45 keV Single-Energy Spectral CT Radiomics Combined with Machine Learning for Predicting Short-Term Efficacy of TACE in Hepatocellular Carcinoma. Journal of Clinical Radiology, 43(12): 2159–2165.
Emegano DI, Mustapha MT, Ozsahin DU, et al., 2025, Machine Learning Prediction of Overall Survival in Prostate Adenocarcinoma Using Ensemble Techniques. Computers in Biology and Medicine, 189: 110008.
Ochs V, Taha-Mehlitz S, Lavanchy JL, et al., 2025, Development of a Clinical Prediction Model for Anastomotic Leakage in Colorectal Surgery. JAMA Network Open, 8(10): e2538267.
Wong GLH, Hui VWK, Tan Q, et al., 2022, Novel Machine Learning Models Outperform Risk Scores in Predicting Hepatocellular Carcinoma in Patients with Chronic Viral Hepatitis. JHEP Reports, 4(3): 100441.
An C, Zuo M, Li W, et al., 2025, An Automated Machine-Learning Model for Prognostic Risk Stratification of Intermediate-Stage Hepatocellular Carcinoma After Transarterial Chemoembolization. International Journal of Surgery, 111(9): 6200–6210.
Zhao KF, Xie CB, Wu Y, 2025, Prediction of the Efficacy of First Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma via a Clinical-Radiomics Model. World Journal of Clinical Cases, 13(23): 33–47.
Huang K, Liu H, Wu Y, et al., 2024, Development and Validation of Survival Prediction Models for Patients with Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemoembolization Plus Tyrosine Kinase Inhibitors. La Radiologia Medica, 129(11): 1597–1610.
Jiao R, Liu Q, Zhang Y, et al., 2025, RECISTSurv: Hybrid Multi-Task Transformer for Hepatocellular Carcinoma Response and Survival Evaluation. IEEE Transactions on Image Processing, 34: 3873–3888.
Lee KH, Lee J, Choi GH, et al., 2025, Deep Learning-Based Prediction of Post-Treatment Survival in Hepatocellular Carcinoma Patients Using Pre-Treatment CT Images and Clinical Data. Journal of Imaging Informatics in Medicine, 38(2): 1212–1223.
Jin ZC, Wei J, Xiao YD, et al., 2025, Decoding Tumor Heterogeneity with Imaging Biomarkers Predicts Response to TACE Plus Immunotherapy and Targeted Therapy in HCC (CHANCE2204). Hepatology, 2025.
Kong C, Zhao Z, Chen W, et al., 2021, Prediction of Tumor Response via a Pretreatment MRI Radiomics-Based Nomogram in HCC Treated with TACE. European Radiology, 31(10): 7500–7511.
Wang J, Liu H, Li Y, et al., 2025, Deep-Learning Radiomics and Hand-Crafted Radiomics Utilizing Contrast-Enhanced MRI to Predict Early Peritumoral Recurrence After DEB-TACE with Hepatocellular Carcinoma: A Two-Center Study. Frontiers in Oncology, 2025: 15.
Luo J, Huang Z, Wang M, et al., 2022, Prognostic Role of Multiparameter MRI and Radiomics in Progression of Advanced Unresectable Hepatocellular Carcinoma Following Combined Transcatheter Arterial Chemoembolization and Lenvatinib Therapy. BMC Gastroenterology, 22(1): 1–11.
Liu QP, Yang KL, Xu X, et al., 2022, Radiomics Analysis of Pretreatment MRI in Predicting Tumor Response and Outcome in Hepatocellular Carcinoma with Transarterial Chemoembolization: A Two-Center Collaborative Study. Abdominal Radiology, 47(2): 651–663.
Peng G, Huang XY, Wang YN, et al., 2024, Prognostic Value of Preoperative MRI-Derived 3D Quantitative Tumor Arterial Burden in Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolization. Radiology: Imaging Cancer, 6(3): e230167.
Kiani I, Razeghian I, Valizadeh P, et al., 2026, Performance of Artificial Intelligence Models in Predicting Responsiveness of Hepatocellular Carcinoma to Transarterial Chemoembolization (TACE): A Systematic Review and Meta-Analysis. Journal of the American College of Radiology, 23(1): 76–88.
Bartnik K, Krzyzinski M, Bartczak T, et al., 2024, A Novel Radiomics Approach for Predicting TACE Outcomes in Hepatocellular Carcinoma Patients Using Deep Learning for Multi-Organ Segmentation. Scientific Reports, 14(1): 1–13.
Liu Y, Liu Z, Li X, et al., 2024, Non-Invasive Assessment of Response to Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma with the Deep Neural Networks-Based Radiomics Nomogram. Acta Radiologica, 65(6): 535–545.
Li J, Zhou M, Tong Y, et al., 2024, Tumor Growth Pattern and Intra- and Peritumoral Radiomics Combined for Prediction of Initial TACE Outcome in Patients with Primary Hepatocellular Carcinoma. Journal of Hepatocellular Carcinoma, 11: 1927–1944.
Wang C, Leng B, You R, et al., 2024, A Transcriptomic Biomarker for Predicting the Response to TACE Correlates with the Tumor Microenvironment and Radiomics Features in Carcinoma. Journal of Hepatocellular Carcinoma, 11: 2321–2337.
Zhang L, Wang Y, Peng Z, et al., 2022, The Progress of Multimodal Imaging Combination and Subregion Based Radiomics Research of Cancers. International Journal of Biological Sciences, 18(8): 3458–3469.