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Background <p>The epidemiological shift toward non-B non-C hepatocellular carcinoma (NBNC-HCC) highlights the need for identifying prognostic markers in this population. While microvascular invasion (MVI) has been established in hepatitis virus-related HCC (HV-HCC), its role in NBNC-HCC remains unclear.</p> Methods <p>This multicenter retrospective study analyzed 3308 patients with HCC undergoing curative resection (2012–2023). Risk factors for MVI were identified using logistic regression in the overall cohort. From this cohort, 439 patients with NBNC-HCC were stratified based on the MVI status and balanced using propensity score matching (PSM). Cox regression models and Kaplan–Meier analysis with log-rank test were employed to compare recurrence-free survival (RFS) and overall survival (OS) between MVI-positive and MVI-negative subgroups.</p> Results <p>The incidence of MVI was lower in the NBNC-HCC group compared to the HV-HCC group (31.44% vs. 38.06%, <i>P</i> = 0.007), but viral hepatitis was not an independent risk factor for MVI (OR = 1.20, 95% CI 0.95–1.51, <i>P</i> = 0.118). After PSM, patients with MVI-positive NBNC-HCC had significantly worse RFS (median 30.0 vs. 47.0&#xa0;months) and OS (median 41.0&#xa0;months vs. not reached) compared to MVI-negative patients (both <i>P</i> &lt; 0.01). MVI independently predicted postoperative recurrence (HR = 2.07, 95% CI 1.46–2.94) and mortality (HR = 2.17, 95% CI 1.45–3.26). MVI-positive cases also demonstrated adverse recurrence patterns, characterized by higher rates of simultaneous intrahepatic and extrahepatic recurrence (17.0% vs. 11.4%) and more frequent recurrence beyond the Milan criteria (39.8% vs. 22.9%).</p> Conclusion <p>MVI independently predicts adverse outcomes in NBNC-HCC, associated with adverse recurrence and reduced survival. The prognostic value of MVI is independent of viral hepatitis, supporting its importance for risk stratification in this population.</p> Graphical abstract <p></p>

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The impact of microvascular invasion in tumor recurrence and survival after liver resection for non-B non-C hepatocellular carcinoma: a multicenter, propensity score-matched analysis

  • 期刊论文

  • 发表日期：

    2026年2月5日

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  • Chen Feng,
  • Tian-Chen Zhang,
  • Yu-Ting Wang,
  • Zhen-Qi Li,
  • Ming-Gen Hu,
  • Yu Cao,
  • Yu-Fu Tang,
  • Fan Zhang,
  • Qing-Qiang Ni,
  • Xiong Chen,
  • Mao-Lin Yan,
  • Nian-Xin Xia,
  • Wen-Chao Zhao,
  • Yi-Lin Hu,
  • Xiao-Dong Tan,
  • Yun-Fei Xu,
  • Guang Tan,
  • Shuai Xu,
  • Hong-Xing Jiang,
  • Zhong-Hua Liu,
  • Shu-Qun Cheng,
  • Xiu-Ping Zhang,
  • Rong Liu

摘要

Background

The epidemiological shift toward non-B non-C hepatocellular carcinoma (NBNC-HCC) highlights the need for identifying prognostic markers in this population. While microvascular invasion (MVI) has been established in hepatitis virus-related HCC (HV-HCC), its role in NBNC-HCC remains unclear.

Methods

This multicenter retrospective study analyzed 3308 patients with HCC undergoing curative resection (2012–2023). Risk factors for MVI were identified using logistic regression in the overall cohort. From this cohort, 439 patients with NBNC-HCC were stratified based on the MVI status and balanced using propensity score matching (PSM). Cox regression models and Kaplan–Meier analysis with log-rank test were employed to compare recurrence-free survival (RFS) and overall survival (OS) between MVI-positive and MVI-negative subgroups.

Results

The incidence of MVI was lower in the NBNC-HCC group compared to the HV-HCC group (31.44% vs. 38.06%, P = 0.007), but viral hepatitis was not an independent risk factor for MVI (OR = 1.20, 95% CI 0.95–1.51, P = 0.118). After PSM, patients with MVI-positive NBNC-HCC had significantly worse RFS (median 30.0 vs. 47.0 months) and OS (median 41.0 months vs. not reached) compared to MVI-negative patients (both P < 0.01). MVI independently predicted postoperative recurrence (HR = 2.07, 95% CI 1.46–2.94) and mortality (HR = 2.17, 95% CI 1.45–3.26). MVI-positive cases also demonstrated adverse recurrence patterns, characterized by higher rates of simultaneous intrahepatic and extrahepatic recurrence (17.0% vs. 11.4%) and more frequent recurrence beyond the Milan criteria (39.8% vs. 22.9%).

Conclusion

MVI independently predicts adverse outcomes in NBNC-HCC, associated with adverse recurrence and reduced survival. The prognostic value of MVI is independent of viral hepatitis, supporting its importance for risk stratification in this population.

Graphical abstract