Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

Abstract

Abstract. The aims of the present study were to examine the relationship between the preoperative FIB-4 index and background liver fibrosis in non-tumor parts obtained from surgical specimens and to investigate whether the FIB-4 index can be a useful predictor for non-B non-C hepatocellular carcinoma (NBNC-HCC) patients treated with surgical resection (SR). A total of 118 patients with NBNC-HCC treated with SR with curative intent were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for the FIB-4 index, aspartate aminotransferase (AST) to platelet ratio index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin and platelet count for cirrhosis. We also examined predictors linked to overall survival (OS) and recurrence-free survival (RFS) after SR. The mean patient age was 68.9±9.0 years (93 males and 25 females) with a median observation period of 3.2 years. In extracted surgical specimens, background liver cirrhosis (F4) was observed in 39 patients (33.1%). The mean maximum tumor size was 5.7±3.2 cm. The mean body mass index was 24.3±3.9 kg/m 2 . The FIB-4 index yielded the highest AUROC for cirrhosis with a level of 0.887 at an optimal cut-off value of 2.97 (sensitivity, 92.3; specificity, 69.6%). In the multivariate analysis, serum α-fetoprotein >40 ng/ml (P=0.026) was the only significant independent predictor linked to OS, while tumor number (P=0.002) and FIB-4 index >2.97 (P=0.044) were significant factors linked to RFS. In conclusion, preoperative FIB-4 index can be a useful predictor for NBNC-HCC patients who undergo SR. IntroductionHepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancerrelated death (1-3). Although most cases of this malignancy are associated with viral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, a substantial proportion of HCC patients are negative for markers of HBV surface antigen (HBsAg) and HCV antibody (HCVAb) [non-B non-C HCC (NBNC-HCC)]. The frequency of NBNC-HCC has been reported to range from 5 to 15%, and the number of NBNC-HCC patients in Japan has recently been gradually increasing (4-7). It is noteworthy that the proportion of NBNC-HCC patients was ~30% in 2011, 2012 and 2013 in our hospital (1).Curative therapies for HCC consist of liver transplantation, surgical resection (SR) and radiofrequency ablation (RFA) (1-7). The clinical outcome of HCC patients undergoing these therapies has improved substantially in recent years due to their advances. However, HCC often recurs even after curative therapies, leading to high mortality. Recurrence only occurs at intrahepatic sites in 68-96% of patients (1,(8)(9)(10). Hence, the identification of predictive factors and effective management of HCC recurrence are essential for improving survival, even after curative treatment.Recently, several noninvasive tools have been introduced to evaluate the degree of hepatic fibrosis in patients with...

Fibrosis-4 Model Influences Results of Patients with Hepatocellular Carcinoma Undergoing Hepatectomy

“…As identified in previous studies [ 8 , 10 , 12 – 14 , 19 ] on noninvasive markers for prediction prognosis, the present study also concludes that fibrosis-4 is able to offer a better overall prediction with regard to survival and disease-free survival for HCC patients subjected to liver resection. In addition, a further difference was observed in the present study.…”

“…However, the conclusions from these studies remain controversial. Whilst some studies reported that fibrosis-4 [ 8 , 10 , 12 – 14 ] provided optimum discrimination capability with respect to liver cirrhosis and also appeared to offer capabilities with respect to predicting long-term outcomes, the study conducted by Choi [ 6 ] indicated that the Forn index was the optimum biomarker, whilst Pang [ 11 ] identified King's score as the optimum option. Therefore, the aim of this paper is to determine whether such noninvasive models have the ability to predict cirrhosis, postoperative complications, and survival in patients presenting with HCC and undergoing hepatectomy with R0 intent and also to determine the optimum approach.…”

Immediate postoperative Fibrosis-4 predicts postoperative liver failure for patients with hepatocellular carcinoma undergoing curative surgery

“…The same as the other fibrosis indexes, FIB-4 has been proved to accurately predict cirrhosis and be an independent prognostic factor for survival and disease-free survival for HCC patients in many studies [19][20][21]. Moreover, several studies [7,12] also found that increased preoperative FIB-4 or APRI may be a predictor of postoperative hepatic failure.…”

Liver Cirrhosis: Evaluation, Nutritional Status, and Prognosis

“…On the other hand, we previously reported that the GSA index as defined by the uptake ratio of the liver to the liver plus heart at 15 min to the uptake ratio of the heart at 15 min to that at 3 min ratio calculated from 99mTc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin (99mTc-GSA) scintigraphy yielded the highest area under the receiver operating curve (AUROC) for predicting histologically proven cirrhosis with a level of 0.786 at an optimal cut-off value of 1.37 (sensitivity: 65.9%; specificity: 79.0%) in HCV-related HCC patient treated with surgical resection (SR) ( n = 213) and it can be a useful predictor for HCC recurrence after surgery [ 32 ]. Furthermore, in non-B and non-C HCC patients treated with SR ( n = 118), we have shown that the FIB-4 index yielded the highest AUROC for histologically proven cirrhosis with a level of 0.887 at an optimal cut-off value of 2.97 (sensitivity: 92.3%; specificity: 69.6%), and FIB-4 index >2.97 ( P = 0.044) was a significant independent factor linked to HCC recurrence [ 33 ].…”