A Combined Ki-67 and Microvascular Invasion Score Predicts Early Recurrence and Survival After Hepatectomy for HCC.
- 1Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China.
Abstract
Background
Both Ki-67 proliferation index and microvascular invasion (MVI) are independent predictors of postoperative recurrence in hepatocellular carcinoma (HCC), but their combined prognostic value remains unclear. This study aimed to develop and internally validate a Combined Ki-67 and MVI Score (CKMS) for predicting recurrence and survival after HCC resection.Methods
A total of 255 HCC patients who underwent curative resection were prospectively enrolled. Based on postoperative pathological findings, the CKMS was constructed by summing graded Ki-67 (0-2 based on 30% and 50% cutoffs) and MVI (0-2 based on M0/M1/M2), yielding a score of 0-4, and patients were stratified into low-risk (0-1), intermediate-risk (2-3), and high-risk (4) groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox proportional hazards models, adjusting for BCLC stage, AFP, age, and adjuvant therapies. Internal validation was performed using bootstrap resampling.Results
The median follow-up duration was 19.0 months (95% CI 16.7-21.3 months). During the follow-up period, 81 patients (31.8%) developed recurrence and 69 patients (27.1%) died. Multivariable Cox regression showed that the CKMS high-risk group was an independent risk factor for both RFS (HR=2.766, 95% CI 1.489-5.139, P<0.001) and OS (HR=8.324, 95% CI 3.768-18.386, P<0.001), and the intermediate-risk group was also significantly associated with OS (HR=2.905, 95% CI 1.550-5.446, P<0.001). BCLC stage C, AFP >11.31 ng/mL, and liver function grade B/C at 1 month post-surgery were also independent prognostic factors. Internal validation and sensitivity analyses showed consistent prognostic effects of the CKMS.Conclusion
The CKMS, based on routine pathological markers, may serve as a simple tool for postoperative risk stratification and individualized follow-up in HCC, but its clinical utility requires external validation.
Related
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BibTeX
@article{jin2026combined,
title = {{A Combined Ki-67 and Microvascular Invasion Score Predicts Early Recurrence and Survival After Hepatectomy for HCC.}},
author = {Wenxiang Jin and Shaoqi Zu and Hong Zhu and Ning Jiang and Chao Yang},
journal = {Journal of hepatocellular carcinoma},
year = {2026},
month = oct,
doi = {10.2147/jhc.s658050},
url = {https://europepmc.org/article/MED/42974461},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - A Combined Ki-67 and Microvascular Invasion Score Predicts Early Recurrence and Survival After Hepatectomy for HCC.
AU - Wenxiang Jin
AU - Shaoqi Zu
AU - Hong Zhu
AU - Ning Jiang
AU - Chao Yang
PY - 2026
DA - 2026/10/29
JO - Journal of hepatocellular carcinoma
DO - 10.2147/jhc.s658050
UR - https://europepmc.org/article/MED/42974461
AB - Background Both Ki-67 proliferation index and microvascular invasion (MVI) are independent predictors of postoperative recurrence in hepatocellular carcinoma (HCC), but their combined prognostic value remains unclear. This study aimed to develop and internally validate a Combined Ki-67 and MVI Score (CKMS) for predicting recurrence and survival after HCC resection.Methods A total of 255 HCC patients who underwent curative resection were prospectively enrolled. Based on postoperative pathological findings, the CKMS was constructed by summing graded Ki-67 (0-2 based on 30% and 50% cutoffs) and MVI (0-2 based on M0/M1/M2), yielding a score of 0-4, and patients were stratified into low-risk (0-1), intermediate-risk (2-3), and high-risk (4) groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox proportional hazards models, adjusting for BCLC stage, AFP, age, and adjuvant therapies. Internal validation was performed using bootstrap resampling.Results The median follow-up duration was 19.0 months (95% CI 16.7-21.3 months). During the follow-up period, 81 patients (31.8%) developed recurrence and 69 patients (27.1%) died. Multivariable Cox regression showed that the CKMS high-risk group was an independent risk factor for both RFS (HR=2.766, 95% CI 1.489-5.139, P<0.001) and OS (HR=8.324, 95% CI 3.768-18.386, P<0.001), and the intermediate-risk group was also significantly associated with OS (HR=2.905, 95% CI 1.550-5.446, P<0.001). BCLC stage C, AFP >11.31 ng/mL, and liver function grade B/C at 1 month post-surgery were also independent prognostic factors. Internal validation and sensitivity analyses showed consistent prognostic effects of the CKMS.Conclusion The CKMS, based on routine pathological markers, may serve as a simple tool for postoperative risk stratification and individualized follow-up in HCC, but its clinical utility requires external validation.
SN - 2253-5969
ER -