Hepatitis B virus (HBV) infection is the main cause of cirrhosis and hepatocellular carcinoma (HCC) in China. Microvascular invasion (MVI) is a key pathological indicator of tumor invasiveness associated with HCC prognosis. This study aimed to investigate the association of cirrhosis with MVI incidence and postoperative prognosis in patients with HBV-related HCC.;Patients with HBV-related HCC who underwent resection in 13 centers in China between February 2011 and June 2023 were included in this study. Risk factors of MVI were analyzed using logistic regression analysis. A propensity score matching (PSM) was performed to eliminate confounders between the groups. Recurrence-free survival (RFS) and overall survival (OS) were estimated based on the Kaplan-Meier method and compared using the log-rank test. Independent risk factors for RFS and OS were identified using Cox regression analysis.;Of 3048 patients with HBV-related HCC, 2271 (74.5%) had cirrhosis. Compared to patients without cirrhosis, the incidence of MVI was higher in patients with cirrhosis (47.8% vs. 41.2%, P = 0.001). Cirrhosis was independently associated with MVI (odds ratio = 1.41, P < 0.001). In patients with MVI, RFS and OS were significantly shorter in patients with cirrhosis than those without cirrhosis (after PSM, median RFS: 13.90 vs. 33.37 months, P < 0.001; median OS: 42.07 vs. 63.67 months, P < 0.001). Cirrhosis was an independent risk factor for RFS and OS in patients with MVI [RFS: hazard ratio (HR) = 1.62, P < 0.001; OS: HR = 1.56, P < 0.001].;Among patients with HBV-related HCC, cirrhosis was associated with the presence of MVI. Cirrhosis was an indicator of worse RFS and OS in patients with MVI.;
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