Integrating tertiary lymphoid structures (TLS) with microvascular invasion (MVI) improves risk stratification in hepatocellular carcinoma (HCC) patients post-surgery.

• Patients with TLS + and MVI – had the best outcomes, while TLS – and MVI + showed the worst, suggesting significant prognostic value.
• In a multi-cohort study of 923 patients, those with TLS + had a recurrence-free survival (RFS) of 19.57 months compared to 8.53 months for TLS -.

This data can guide personalized treatment strategies, helping to identify patients who may benefit most from adjuvant therapies like hepatic arterial infusion chemotherapy.

• No overall survival difference was found between TLS + and TLS – groups in the therapy cohort.