Background/ObjectiveEarly recurrence (ER) affects the long-term survival prognosis of patients with hepatocellular carcinoma (HCC). Many previous studies have utilized CT/MRI-based radiomics to predict ER after radical treatment, achieving high predictive value. However, the diagnostic performance of radiomics for the preoperative identification of ER remains uncertain. Therefore, we aimed to perform a meta-analysis to investigate the predictive performance of radiomics for ER in HCC.MethodsA systematic literature search was conducted in PubMed, Web of Science (including MEDLINE), EMBASE and the Cochrane Central Register of Controlled Trials to identify studies that utilized radiomics methods to assess ER in HCC. Data were extracted and quality assessed for retrieved studies. Statistical analyses included pooled data, tests for heterogeneity, and publication bias. Meta-regression and subgroup analyses were performed to investigate potential sources of heterogeneity.ResultsThe analysis included fifteen studies involving 3,281 patients focusing on preoperative CT/MRI-based radiomics for the prediction of ER in HCC. The combined sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic were 75% (95% CI: 65-82), 78% (95% CI: 68-85), and 83% (95% CI: 79-86), respectively. The combined positive likelihood ratio, negative likelihood ratio, diagnostic score, and diagnostic odds ratio were 3.35 (95% CI: 2.41-4.65), 0.33 (95% CI: 0.25-0.43), 2.33 (95% CI: 1.91-2.75), and 10.29 (95% CI: 6.79-15.61), respectively. Substantial heterogeneity was observed among the studies (I²=99%; 95% CI: 99-100). Meta-regression showed imaging equipment contributed to the heterogeneity of specificity in subgroup analysis (P= 0.03).ConclusionPreoperative CT/MRI-based radiomics appears to be a promising and non-invasive predictive approach with moderate ER recognition performance.