Interaction between microvascular invasion and early recurrence of hepatocellular carcinoma in cirrhosis patients with curative liver resection: a retrospective cohort study.
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OBJECTIVE: To investigate the independent effects and potential effect modification by liver function reserve on the prognostic value of MVI for early recurrence in patients with hepatocellular carcinoma (HCC) arising from cirrhosis following curative liver resection (CLR). METHODS: A retrospective cohort study was conducted, consecutively enrolling 120 patients who underwent CLR with histopathologically confirmed HCC arising from cirrhosis between January 2021 and December 2023. MVI status (positive/negative) was determined based on postoperative pathological reports. Preoperative clinical data were used to assess Child-Pugh class (A/B). The primary endpoint was early tumor recurrence within 24 months post-surgery. A multivariate Cox model incorporating an effect modification between MVI and Child-Pugh class was constructed to evaluate their potential effect modification. RESULTS: A total of 120 patients were included, of whom 54 (45.0%) were MVI-positive. Early recurrence occurred in 50 patients (41.67%). MVI positivity (HR = 4.00), tumor size > 5 cm, anatomical liver resection, and Edmondson grade III-IV were identified as independent risk factors for early recurrence. A significant effect modification between MVI and Child-Pugh class was observed (interaction HR = 0.11, 95% CI: 0.03-0.40, P = 0.001), which remained stable after bootstrap internal validation. The risk effect of MVI positivity was strongest in patients with Child-Pugh class A, whereas this effect was significantly attenuated in patients with Child-Pugh class B. Based on this interaction, patients were stratified into low-risk, low-intermediate risk, high-intermediate risk, and high-risk groups. The high-risk group exhibited a significantly increased risk of recurrence compared to the low-risk group. CONCLUSION: A risk assessment model integrating MVI status and Child-Pugh class may help stratify patients. The prognostic value of MVI appears to be modified by liver function reserve, with the strongest effect observed in patients with well-preserved liver function (Child-Pugh A). These findings suggest potential value for personalized postoperative management, pending further validation.