Prognostic analysis of postoperative pathological microvascular invasion in hepatocellular carcinoma and the effect of surgical margin on prognosis: a retrospective cohort study

BACKGROUND: The aim of this study was to analyze the impact of different microvascular invasion (MVI) grades, and surgical margins on hepatocellular carcinoma patient survival after liver resection.METHODS: Between January 2016 and December 2020, we retrospectively analyzed the clinicopathological data of 513 hepatocellular carcinoma patients underwent liver resection in our department. T-test and χ2 test were used to analyze the difference of clinical variances between patients with or without MVI. Univariate and multivariate COX regression analysis were applied to determine whether MVI is independent prognostic factor of patient survival.RESULTS: Among the patients, there were 332 cases in M0 group, 123 cases in M1 group and 58 cases in M2 group. Univariate and multivariate analysis showed that tumor diameter and alpha-fetoprotein level were risk factors for MVI in patients with HCC (P<0.05), There was no significant difference in the incidence of postoperative complications among different groups. Patient with MVI had worse postoperative survival than patients without MVI (P<0.001). Moreover, Patient with MVI had worse postoperative progression free survival (P<0.001). In the aspect of surgical margin, in MVI negative group, the postoperative survival of wide and narrow margin resection patients was not statistical significantly different (P>0.05). In the MVI positive group, patients with narrow margin resection have worse overall survival (P=0.032) and progression free survival (P=0.027).CONCLUSIONS: Tumor diameter and AFP are independent risk factors for MVI in hepatocellular carcinoma patients. Patient whit higher MVI grades had worse postoperative survival. For patients with MVI positive liver cancer, wider surgical margin indicates better postoperative survival.