Pathological characteristics of hepatocellular carcinoma: A dual-center correlation analysis and validation

doi:10.4251/wjgo.119082

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Sep 15, 2026; 18(9): 119082
Published online Sep 15, 2026. doi: 10.4251/wjgo.119082

Pathological characteristics of hepatocellular carcinoma: A dual-center correlation analysis and validation

Hai-Bo Huang, Ying-Dan Zhang, Jie Yang, Ying-Ying Huang, Li-Feng Huang, Shuang-Yue Wang, Wei Lu, Ze-He Huang, Ke Ding

Hai-Bo Huang, Ying-Dan Zhang, Jie Yang, Li-Feng Huang, Ke Ding, Department of Radiology, The Third Affiliated Hospital of Guangxi Medical University, Nanning 530031, Guangxi Zhuang Autonomous Region, China

Ying-Ying Huang, Ze-He Huang, Department of Radiology, The First People’s Hospital of Qinzhou, Qinzhou 530550, Guangxi Zhuang Autonomous Region, China

Shuang-Yue Wang, Department of Oncology, The Third Affiliated Hospital of Guangxi Medical University, Nanning 530031, Guangxi Zhuang Autonomous Region, China

Wei Lu, Department of Pathology, The Third Affiliated Hospital of Guangxi Medical University, Nanning 530031, Guangxi Zhuang Autonomous Region, China

Co-first authors: Hai-Bo Huang and Ying-Dan Zhang.

Co-corresponding authors: Ze-He Huang and Ke Ding.

Author contributions: Huang HB and Zhang YD performed formal and statistical analyses, and drafted the original manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Huang HB, Huang ZH, and Ding K conceptualized the work, supervised the project, and critically revised the manuscript; Zhang YD, Yang J, Huang YY, and Lu W curated and validated the data; Yang J, Huang LF, and Wang SY conducted investigations, developed methodologies, and provided resources; Ding K secured funding and additional resources; Huang ZH and Ding K contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final manuscript.

AI contribution statement: AI tools (DeepSeek-R1) was indeed used during the drafting process, primarily to help translate the reviewers’ comments and polish the English wording of our responses. Academic judgments such as the study design and interpretation of results were made entirely by the authors without any AI involvement.

Supported by Self-Raised Research Projects from the Health Commission of Guangxi Zhuang Autonomous Region, China, No. Z20200953.

Institutional review board statement: This study was approved by the Medical Ethics Committee of the Medical Ethics Committee of Nanning Second People’s Hospital (the Third Affiliated Hospital of Guangxi Medical University), approval No. Y2025341.

Informed consent statement: The requirement for informed consent was waived by the ethics committee owing to the retrospective nature of the study and the use of fully anonymized data.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available owing to hospital data governance policies but are available from the corresponding author (Ke Ding, 272480365@qq.com) upon reasonable request, subject to approval by the Ethics Committee of the Third Affiliated Hospital of Guangxi Medical University.

Corresponding author: Ke Ding, MD, Professor, Department of Radiology, The Third Affiliated Hospital of Guangxi Medical University, No. 13 Dancun Road, Nanning 530031, Guangxi Zhuang Autonomous Region, China. 272480365@qq.com

Received: January 26, 2026
Revised: March 28, 2026
Accepted: May 14, 2026
Published online: September 15, 2026
Processing time: 213 Days and 4.5 Hours

Abstract

BACKGROUND

High Ki-67 expression promotes epithelial-mesenchymal transition and angiogenesis, thereby increasing the risk of microvascular invasion (MVI) and satellite nodules (SN) in hepatocellular carcinoma (HCC). The synergistic interplay among these pathological characteristics is critical for prognostic assessment; however, robust multicenter validation remains lacking.

AIM

To validate the interrelationships within the “Edmondson grade-MVI-SN-Ki-67” aggressive pathological cluster and to evaluate the predictive value of Ki-67 for SN.

METHODS

A retrospective analysis was conducted on 223 patients with HCC who underwent surgical resection at two independent clinical centers. Spearman correlation and receiver operating characteristic curve analyses were performed.

RESULTS

The pathological features demonstrated strong intercorrelations, with MVI and SN exhibiting the strongest association (r_s = 0.637, odds ratio = 75.833). Ki-67 displayed optimal and consistent predictive performance for SN positivity across both centers (area under the curve = 0.792). A uniform Ki-67 cutoff value of 32.5% was identified, yielding high specificity (0.813). The predictive performance of Ki-67 for SN showed no significant difference between centers (area under the curve = 0.780 vs 0.835, P = 0.372). In multivariate analysis, Ki-67 remained an independent predictor of SN after adjusting for study center (odds ratio = 1.058, P < 0.001).

CONCLUSION

Key pathological characteristics of HCC constitute a tightly linked aggressive cluster. Ki-67 serves as a reproducible predictive biomarker for SN positivity, providing validated multicenter pathological evidence for postoperative risk stratification.

Keywords: Hepatocellular carcinoma; Edmondson-Steiner grading; Ki-67; Microvascular invasion; Satellite nodule; Biomarker

Core Tip: This dual-center retrospective study validates a tightly linked aggressive pathological cluster (Edmondson grade, microvascular invasion, satellite nodules, Ki-67) in hepatocellular carcinoma. We identify Ki-67 as a core, reproducible biomarker, with a validated cutoff of 32.5% demonstrating high specificity (0.813) for predicting satellite nodules positivity across two independent centers. These findings provide multicenter pathological evidence to inform postoperative risk stratification and adjuvant therapy decisions.