Abstract
BACKGROUND AND OBJECTIVE: Hepatocellular carcinoma (HCC) is one of the malignancies with increasing incidence globally, and microvascular invasion (MVI) is a crucial determinant of prognosis in patients. This study aimed to investigate platelet distribution width (PDW) and diabetes mellitus as indicators for predicting preoperative MVI in HCC, providing more accurate predictive tools for clinicians to guide treatment strategies and improve patient survival and quality of life. METHODS: A retrospective study was conducted, including 1357 patients who underwent hepatectomy for HCC between January 2008 and December 2014 at the Eastern Hepatobiliary Surgery Hospital in China. Clinical, pathological, and radiological data, including PDW and diabetes status, were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for MVI and establish a predictive model. The predictive performance of the model was evaluated through nomograms and internal validation. RESULTS: Univariate analysis revealed significant associations between MVI and diabetes mellitus, presence of liver cirrhosis, prealbumin level, tumor diameter, number of tumors, HBV DNA viral load > 10(4), and PDW ≥ 17. Multivariate logistic regression analysis identified diabetes mellitus, liver cirrhosis, prealbumin level, tumor diameter, number of tumors, HBV DNA viral load > 10(4), and PDW ≥ 17 as independent risk factors for MVI. Based on these findings, a predictive model was established, demonstrating high predictive accuracy and stability in both the training and validation cohorts. CONCLUSION: This study confirmed PDW and diabetes mellitus as reliable indicators for predicting preoperative MVI in HCC and established a corresponding predictive model. Future research should further explore the underlying mechanisms and enhance clinical validation to advance the field of HCC treatment.