1From the Department of Radiology, Université Paris Cité, Paris, France (M.R.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.); Departments of Medical Oncology (A.B.) and Internal Medicine (J.C.), University of California-San Diego, La Jolla, Calif; Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); and Department of Radiology, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122 (K.J.F.).
The focus of hepatocellular carcinoma (HCC) research for many years has been on noninvasive diagnosis. Standardized systematic algorithms composed of combinations of precise features now serve as diagnostic imaging markers of HCC and constitute a major innovation for liver imaging. In clinical practice, the diagnosis of HCC is based primarily on imaging and secondarily on pathologic analysis if the imaging features are not specific. Whereas accurate diagnosis is essential, the next phase of innovation for HCC will likely encompass predictive and prognostic markers. HCC is a biologically heterogeneous malignancy because of complex molecular, pathologic, and patient-level factors that impact the outcomes of treatment. In recent years, there have been many advances in systemic therapy to augment and extend the existing large cache of local and regional options. However, the guideposts for treatment decisions are neither sophisticated nor individualized. This review provides an overview of prognosis in HCC from the patient to the imaging feature level with a focus on future directions toward more individualized treatment guidance.