Nitta H, et al. - Researchers examined 681 consecutive patients who underwent hepatic resection (HR) or liver transplantation (LT) for hepatocellular carcinoma to determine how the location of microvascular invasion (MVI) influence patient outcome. In addition, they used 637 patients, excluding 44 patients with macrovascular invasion, for creating a nomogram for predicting extratumoral MVI. Validation of the nomogram was done using an internal (n = 273) and external patient cohort (n = 256). Observations revealed differences in the prognostic value of MVI according to its invasiveness. They identified six independent risk factors for extratumoral MVI in multivariate logistic regression analysis: α-fetoprotein, tumor size, non-boundary type, alkaline phosphatase, neutrophil-to-lymphocyte ratio, and aspartate aminotransferase. In patients undergoing HR or LT, the nomogram using these factors allowed reliable prediction of extratumoral MVI.