Table 2.

Established HCC treatment pathways and potential precision refinement.

Established treatment pathway	Primary clinical determinants	Potential precision refinement	Current evidence status
Hepatic resection	Liver function, portal hypertension, tumor burden, vascular involvement, technical resectability, performance status	Refinement of recurrence-risk assessment, MVI risk, biological aggressiveness, and perioperative risk using radiomics, biomarkers, AI, and host factors	Established treatment; precision refinement remains investigational
Liver transplantation	Liver function, tumor burden, transplant criteria, portal hypertension, extrahepatic disease, patient suitability	Biological response, AFP dynamics, and emerging molecular or circulating biomarkers may refine selection and post-treatment assessment	Established treatment pathway; most biological refinements remain investigational
Ablation	Tumor size, number, location, liver function, and technical feasibility	Imaging-derived tumor phenotype and biological risk may support patient selection and recurrence-risk stratification	Established treatment; precision refinement remains investigational
Locoregional therapy	Tumor burden, vascular involvement, liver function, extrahepatic disease, and treatment feasibility	Imaging phenotype, treatment-response assessment, and emerging biomarkers may help refine treatment selection and sequencing	Established treatment; precision refinement remains investigational
Systemic therapy	Tumor stage, liver function, performance status, prior treatment, and treatment eligibility	Molecular, immune, and circulating biomarkers may refine biological characterization and treatment-response assessment	Established treatment; biomarker-guided selection remains limited and investigational
Conversion surgery/multimodality treatment	Initial unresectability, treatment response, residual disease, liver function, and technical resectability	Dynamic imaging, biological response, ctDNA, and AI-based prediction may potentially assist assessment of treatment response and timing of reassessment for surgery	Promising but not yet standardized; precision-guided selection remains investigational
Surveillance and recurrence management	Tumor stage, recurrence risk, liver disease status, and established imaging/laboratory surveillance	Longitudinal biomarkers, radiomics, AI, and digital monitoring may refine recurrence-risk assessment and surveillance intensity	Established surveillance principles; emerging tools remain investigational