CT Radiomics Adds Little to Survival Prediction After TACE in Liver Cancer and Fails External Validation

CT radiomics did not improve survival prediction over clinical models for HCC after TACE (internal C-index 0.593 vs 0.646) and showed poor discrimination in external testing (C-index 0.463, 95% CI 0.397–0.532), adding no incremental value.

• In the internal cohort (221 patients), a tumor-radiomics score (R1 Top‑K=15) had lower C‑index than the clinical model alone (0.593 vs 0.646), and the combined model did not outperform the clinical model.
• Frozen external validation in 98 clinically distinct patients yielded C‑indices of 0.463–0.535, well below thresholds for clinical utility, and the combined clinical‑radiomics model was not externally tested.

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