A novel pathologic scoring system for predicting postoperative recurrence in BCLC stage 0-A hepatocellular carcinoma patients: a nationwide multicenter study

This study aimed to develop and validate a novel pathological scoring system, the MSE score (microvascular invasion, satellite foci, Edmondson-Steiner grade), for predicting postoperative recurrence in hepatocellular carcinoma (HCC) patients at BCLC stage 0-A following liver resection. The MSE score was compared to the established microvascular invasion/satellitosis (mVI/S) scoring system, which combines microvascular invasion and satellite nodules, both of which are significant predictors of aggressive recurrence and mortality. A total of 3,338 patients from 28 centers, who underwent curative liver resection between January 2017 and January 2020, were included. These patients were divided into a training cohort (n=2,337) and a validation cohort (n=1,001). Univariate and multivariate Cox regression models, along with Kaplan-Meier survival analysis, receiver operating characteristic (ROC) curves, and random forest modeling, were used to assess recurrence factors and compare predictive performance. The results showed that the MSE score had superior discriminatory power compared to mVI/S in predicting recurrence and overall survival. Kaplan-Meier analysis indicated a significantly better separation of low- and high-risk groups with the MSE score (P​5 years. Multivariate Cox analysis demonstrated higher predictive power for the MSE score (HR=2.900 (1.808–4.652)) compared to mVI/S (HR=2.134 (1.567–3.043)). Additionally, logistic regression confirmed that the MSE score had stronger predictive power for aggressive recurrence (OR=2.992 (1.816–4.862) vs. mVI/S OR=1.847 (1.105–3.470)). SHAP analysis highlighted that the MSE score was more significant than mVI/S. The MSE score also outperformed traditional BCLC staging, TNM staging, and preoperative serum AFP levels in predicting recurrence. In conclusion, the MSE score provides reliable predictions for postoperative aggressive recurrence and survival in BCLC stage 0-A HCC, offering superior risk stratification compared to mVI/S and promising utility in guiding postoperative management.