Artificial intelligence predicts outcome-related molecular profiles and vascular invasion in hepatocellular carcinoma

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Tobias Paul Seraphin - , University Hospital Duesseldorf, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) (Author)
  • Agavni Mesropian - , University of Barcelona (Author)
  • Laura Žigutytė - , Else Kröner Fresenius Center for Digital Health (Author)
  • James Brooks - , University Hospital Duesseldorf (Author)
  • Ezequiel Mauro - , University of Barcelona (Author)
  • Albert Gris-Oliver - , University of Barcelona (Author)
  • Roser Pinyol - , University of Barcelona (Author)
  • Carla Montironi - , University of Barcelona (Author)
  • Ugne Balaseviciute - , University of Barcelona (Author)
  • Marta Piqué-Gili - , University of Barcelona (Author)
  • Júlia Huguet-Pradell - , University of Barcelona, Icahn School of Medicine at Mount Sinai (Author)
  • Marko van Treeck - , Else Kröner Fresenius Center for Digital Health (Author)
  • Michael Kallenbach - , University Hospital Duesseldorf, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) (Author)
  • Anne Theres Schneider - , University Hospital Duesseldorf (Author)
  • Christoph Roderburg - , University Hospital Duesseldorf, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) (Author)
  • Jakob Nikolas Kather - , Department of Internal Medicine I, Else Kröner Fresenius Center for Digital Health, National Center for Tumor Diseases (NCT) Heidelberg (Author)
  • Tom Luedde - , University Hospital Duesseldorf, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) (Author)
  • Josep M. Llovet - , University of Barcelona, Icahn School of Medicine at Mount Sinai, ICREA - Catalan Institution for Research and Advanced Studies (Author)

Abstract

Background & Aims: Advances in digital pathology and artificial intelligence (AI) are driving progress toward personalized clinical management. In hepatocellular carcinoma (HCC), AI-based models using digitized H&E slides can be a robust tool to predict outcome-related molecular profiles and presence of microvascular invasion (mVI), with potential clinical utility. Methods: A transformer-based deep-learning (DL) model was deployed using digitized H&E slides from 431 resected HCC cases (training cohort). Five-fold cross-validation was applied, and the model was tested on two external cohorts: TCGA-LIHC (n = 363) and advanced-stage HCC cohort (n = 64). Results: The DL model effectively predicted outcome-related molecular profiles, distinguishing poor-prognosis (S1/S2, proliferation) from good-prognosis (S3, non-proliferation) subclasses. In internal cross-validation, mean areas under the curves (AUCs) were 0.75 for proliferation and 0.79 for non-proliferation subclasses. This performance was reproduced in the TCGA test set, with AUCs ranging from 0.72–0.80, and in the advanced-stage HCC cohort, with AUCs ranging from 0.76–0.81. In these test sets, the AI-predicted non-proliferation subclass was associated with a longer median OS compared with the proliferation subclass (5.8 vs. 3.5 years in TCGA; p = 0.02). For mVI prediction, the DL model achieved a mean AUC of 0.70 in the internal cross-validation and 0.62 in the TCGA. AI-predicted mVI was associated with shorter OS (4.9 vs. 7.6 years for non-mVI; p = 0.003) and an immunosuppressive microenvironment (p = 0.002). Conclusions: Our H&E-based AI model enables accurate prediction of outcome-related molecular subtypes of poor prognosis and presence of mVI, offering a scalable and accessible tool to extract clinically relevant features from routine histology. Impact and implications: Outcome-related molecular profiles and the presence of microvascular invasion (mVI) are critical determinants of prognosis and treatment decisions in hepatocellular carcinoma (HCC). This study presents an artificial intelligence (AI)-based method that analyzes routine H&E-stained slides and accurately predicts: (a) biologically relevant HCC molecular subtypes associated with patient outcomes, and (b) the presence of mVI, a well-established predictor of poor outcomes and risk of recurrence, that currently requires meticulous pathological assessment of multiple H&E slides. These AI tools can offer a scalable method to support personalized treatment decisions, such as transplant eligibility, trial enrollment, or neo/adjuvant therapy planning, and may improve clinical management of HCC. Our findings lay the groundwork for incorporating AI-assisted pathology into future prospective studies aimed at improving HCC clinical management.

Details

Original languageEnglish
Article number101592
Number of pages12
JournalJHEP Reports
Volume7
Issue number12
Publication statusPublished - Dec 2025
Peer-reviewedYes

External IDs

ORCID /0000-0002-3730-5348/work/201625042
ORCID /0009-0000-2447-2959/work/201625096
PubMed 41321933

Keywords

Keywords

  • AI, Deep learning, Digital pathology, HCC, Molecular classes, mVI, Prognosis, Tumor biology