This retrospective observational study aims to evaluate whether artificial intelligence (AI) models can predict aggressive recurrence in patients who underwent liver resection for early-stage hepatocellular carcinoma (HCC). The main question it seeks to answer is:

Can deep learning models combining preoperative MRI, postoperative pathology slides, and clinical data accurately identify HCC patients at high risk of aggressive recurrence after surgery?

To answer this, the investigators will analyze existing medical data (preoperative MRIs, postoperative whole-slide images, and clinical records) from 579 patients across two medical centers. All data will be anonymized before analysis, and no additional interventions are required from participants.

This study may help clinicians stratify high-risk patients who could benefit from closer surveillance or adjuvant therapies

Inclusion Criteria:

• Patients who underwent curative liver resection (R0) for pathologically confirmed primary HCC
• BCLC stage 0-A at diagnosis
• Availability of preoperative contrast-enhanced MRI performed within 1 month before surgery
• Availability of postoperative H&E-stained whole slide images (WSIs) with adequate tumor representation
• Complete clinical follow-up data (minimum 2 years if no recurrence)

Exclusion Criteria:

• R1/R2 resection (micro/macroscopically positive margins)
• Missing or poor-quality preoperative MRI (motion artifacts/insufficient contrast enhancement)
• Received neoadjuvant or adjuvant therapy (to avoid treatment confounding)
• Incomplete follow-up (loss to follow-up or missing recurrence status)
• Non-curative procedures (e.g., palliative resection)

This retrospective multicenter study analyzed 579 patients with early-stage hepatocellular carcinoma (HCC) who underwent curative liver resection at two tertiary academic medical centers in China. The study population consisted of:

Primary Cohort (Training/Validation):

462 patients from Tongji Hospital (2018-2021)

External Test Cohort:

117 patients from Sun Yat-sen Memorial Hospital (2021-2022) All patients met strict inclusion criteria: curative (R0) resection, preoperative MRI within 1 month before surgery, available postoperative pathology slides, and complete follow-up. The population represents typical early-stage HCC patients eligible for surgical resection in endemic areas.