Objective To systematically evaluate the correlation between the expression of immunohistochemical markers (Ki-67, GPC-3, and CD34) and overall survival as well as magnetic resonance imaging (MRI) features in patients with hepatocellular carcinoma (HCC), and to construct a survival prediction model integrating molecular biomarkers and imaging characteristics.

Methods We retrospectively analyzed 48 HCC patients admitted to the Chinese PLA General Hospital of Northern Theater Command between January 2018 and June 2021. Kaplan–Meier curves and the Log-rank test were used to compare survival between groups. The chi-square test was applied to compare categorical variables. Multivariate Cox regression was employed to identify independent prognostic factors and to establish a prognostic index formula. Model performance was validated using the Bootstrap method (C-index and IDI).

Results The mean survival times were (996.99 ± 89.72) days for the Ki-67-positive group (Ki-67≥30%) and (1117.40 ± 145.49) days for the Ki-67-negative group (P<0.05). High Ki-67 expression was significantly associated with irregular lesion margins, arterial-ring formation, and vascular invasion (P<0.05). The mean survival times were (917.95 ± 90.14) days for the GPC-3-positive group and (1115.40 ± 153.14) days for the GPC-3-negative group (P < 0.05); GPC-3 expression correlated with the arterial-ring sign and vascular invasion (P<0.05). For CD34, mean survival was (1017.55 ± 90.15) days in the positive group and (1079.74 ± 144.19) days in the negative group. CD34 expression was associated with tumor size >3 cm and vascular invasion (P<0.05), but multivariate analysis showed no independent prognostic value (HR=1.15, P=0.210). The prognostic prediction model based on multivariate Cox regression was: PI = 0.615 × Ki-67 + 0.531 × GPC-3 + 0.336 × tumor size + 0.470 × vascular invasion. The C-index of the validation cohort was 0.78 (95% CI: 0.70–0.86). Risk stratification showed 3-year survival rates of >65% in the low-risk group (PI≤0.8), 30–65% in the intermediate-risk group (0.8<PI≤1.6), and <30% in the high-risk group (PI>1.6) (Log-rank P<0.001).

Conclusions Ki-67 and GPC-3 are independent prognostic factors for HCC, and their high expression is significantly associated with characteristic MRI signs (irregular margins, arterial rings, and vascular invasion). CD34 mainly reflects tumor size and invasiveness but has no independent prognostic value. The developed prediction model enables individualized risk stratification and provides a quantitative basis for clinical treatment decisions (targeted/immunotherapy or liver-transplantation evaluation).