Abstract: Objective To investigate the influencing factors of postoperative microvascular invasion （MVI） in hepatocellular carcinoma （HCC） patients and provide a theoretical basis for neoadjuvant therapy. Methods Clinical data of 995 HCC patients who underwent surgery at Sun Yat-sen Memorial Hospital between January 2020 and December 2023 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for MVI positivity. Results A total of 995 patients were included, with an MVI positivity rate of 38.4% （382/995）. Univariate analysis revealed significant differences between MVI-positive and MVI-negative groups in tumor stage （P<0.001）, differentiation grade （P<0.001）, and proportion of preoperative adjuvant therapy （P=0.044）. Multivariate analysis demonstrated that advanced tumor stage （OR=3.171） and absence of preoperative adjuvant therapy （OR=3.312） were independent risk factors for MVI positivity, while well-differentiated tumors served as a protective factor （OR=0.275） （all P<0.05 ）. Conclusion Higher tumor stage, poorer differentiation, and absence of preoperative adjuvant therapy significantly increase the risk of postoperative MVI in HCC patients. Individualized preoperative adjuvant therapy based on tumor stage and differentiation grade may reduce MVI risk.

Key words: hepatocellular carcinoma, microvascular invasion, neoadjuvant therapy, multivariate analysis

摘要： 目的 探讨肝细胞肝癌（HCC）患者术后MVI阳性的影响因素,为新辅助治疗提供理论基础。方法 回顾性分析2020年1月至2023年12月在孙逸仙纪念医院接受手术治疗的995例HCC患者临床资料,通过单因素和多因素Logistic回归分析MVI阳性的独立危险因素。结果 共纳入995例患者,MVI阳性率为38.4%（382/995）。单因素分析显示,MVI阳性组与阴性组在肿瘤分期（P<0.001）、分化程度（P<0.001）及术前辅助治疗比例（P=0.044）上存在显著差异。多因素分析表明,晚期分期（OR=3.171）和未接受术前辅助治疗（OR=3.312）是MVI阳性的独立危险因素,高分化是MVI阳性的保护因素（OR=0.275）（均P<0.05）。结论 HCC患者肿瘤分期越晚、分化程度越低、未行术前辅助治疗,术后MVI发生风险显著升高。基于术前分期和分化程度的个体化术前辅助治疗可能降低MVI风险。

关键词: 肝细胞肝癌, 微血管侵犯（MVI）, 新辅助治疗, 多因素分析