AI-Powered surveillance may outsmart liver cancer recurrence

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age 18 years or older at the time of informed consent. * First diagnosis of hepatocellular carcinoma, confirmed by histopathology for participants undergoing liver resection, or by histopathology or accepted guideline-concordant imaging criteria for participants undergoing thermal ablation. * Completion of first curative-intent treatment consisting of either R0 liver resection with microscopically tumor-negative margins or complete radiofrequency or microwave ablation of all known hepatocellular carcinoma. * Qualifying multiphasic contrast-enhanced CT or MRI obtained 28 to 56 days after completion of the final curative-intent procedure. * Qualifying imaging confirming no viable tumor at the resection bed or ablation site, no new intrahepatic hepatocellular carcinoma, and no macrovascular invasion, regional nodal disease, or extrahepatic metastasis. * No unresolved lesion requiring immediate diagnostic evaluation or treatment at the time of randomization. * Randomization within 14 days after the qualifying post-treatment imaging assessment and before the first protocol-scheduled surveillance examination. * Eastern Cooperative Oncology Group performance status of 0 or 1. * Child-Pugh class A liver function. * Medically fit for at least one protocol-defined curative-intent salvage treatment should an anatomically amenable recurrence be detected. * Able to undergo repeated protocol-required multiphasic contrast-enhanced CT or MRI examinations. * Availability of the minimum mandatory baseline data elements required to generate an output from the locked artificial intelligence system. * Able and willing to comply with trial procedures and provide written informed consent. Exclusion Criteria: * Any previous episode of hepatocellular carcinoma or previous hepatocellular carcinoma-directed treatment before the current index diagnosis. * Microscopically or macroscopically positive surgical margins (R1 or R2 resection). * Residual viable tumor after thermal ablation. * Any radiological evidence of residual, recurrent, nodal, or metastatic hepatocellular carcinoma at screening. * Macrovascular invasion, regional lymph-node metastasis, or extrahepatic metastasis associated with the index hepatocellular carcinoma. * Index treatment involving liver transplantation, combined resection and ablation, transarterial therapy, radiotherapy, systemic anticancer therapy, or another hepatocellular carcinoma-directed treatment other than the qualifying R0 resection or complete radiofrequency or microwave ablation. * Previous liver transplantation, active placement on a liver-transplant waiting list, or planned liver transplantation in the absence of documented recurrent hepatocellular carcinoma. * Planned or ongoing adjuvant antineoplastic treatment intended to reduce hepatocellular carcinoma recurrence after the qualifying procedure. Guideline-concordant antiviral treatment and management of the underlying liver disease are permitted. * Concurrent participation in another interventional study expected to affect hepatocellular carcinoma recurrence, survival, surveillance intensity, or eligibility for curative-intent salvage treatment. * Combined hepatocellular-cholangiocarcinoma or another non-hepatocellular primary hepatic malignancy. * A permanent medical contraindication that would preclude all protocol-defined curative-intent salvage treatment options. * Inability to undergo any protocol-permitted contrast-enhanced CT or MRI modality because of contraindication to all available imaging and contrast options. * Active malignancy other than hepatocellular carcinoma that requires anticancer treatment or is expected to materially interfere with survival, surveillance adherence, or outcome assessment during the primary 24-month follow-up period. * Uncontrolled hepatic decompensation, including refractory ascites or clinically significant hepatic encephalopathy. * Pregnancy at the time of randomization. * Inability or unwillingness to provide informed consent or comply with protocol-specified follow-up.