Preoperative nomogram for predicting microvascular invasion and stratifying recurrence risk in early-stage...

Microvascular invasion (MVI) is a key determinant of early recurrence and poor prognosis in hepatocellular carcinoma (HCC). However, it can only be diagnosed pathologically after surgery, making reliable preoperative prediction challenging. We aimed to establish and validate a practical preoperative model to predict MVI and risk of recurrence in patients with early-stage HCC. A total of 1,196 patients with BCLC 0-A stage HCC who underwent curative liver resection were retrospectively analyzed. Preoperative clinical and radiological variables were evaluated to identify independent predictors of MVI using multivariate logistic regression. A nomogram was constructed and internally validated to estimate the individual probability of MVI, and disease-free survival (DFS) was compared between the risk groups derived from the nomogram. MVI was pathologically confirmed in 327 of the 1,196 patients (27.3%). In the training and validation cohorts, the nomogram incorporating alpha-fetoprotein (AFP), tumor size, neutrophil-to-lymphocyte ratio (NLR), prothrombin time (PT) and age achieved concordance indexes of 0.72 (95% CI, 0.68-0.75) and 0.73 (95% CI, 0.67-0.79), respectively, with good calibration performance. Patients stratified into the high-risk group based on the nomogram-derived score exhibited significantly shorter DFS than those in the low-risk group (P < 0.001), thereby substantiating the model's prognostic utility. Overall, the proposed nomogram model exhibited satisfactory performance in predicting MVI Preoperatively and stratifying recurrence risk in patients with early-stage HCC, thus facilitating individualized risk assessment and treatment planning.