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

Abstract

Background Several noninvasive models based on routine laboratory index have been developed to predict liver fibrosis. Our aim is to discuss whether these indexes could predict prognosis in patients with hepatocellular carcinoma undergoing hepatectomy. Methods This study retrospectively enrolled 788 consecutive hepatocellular carcinoma patients undergoing liver resection in the cohort. Univariate and multivariate analysis were used to identify the risk factors of complications, survival, and disease-free survival. Results Fibrosis-4 index had the best prediction ability for cirrhosis among other noninvasive models. Both the univariate and multivariate analyses showed that fibrosis-4 was independent risk factor for survival and disease-free survival. With the optimal cutoff value of 3.15, patients with fibrosis-4 ⩾3.15 had higher postoperative hepatic insufficiency (P=0.006) and worse survival than the fibrosis-4<3.15 group. The corresponding 1-year, 3-year, and 5-year overall survival were 80.9%, 56.3%, and 44.6% in the High fibrosis-4 group and were 86.5%, 69.9%, and 63.2% in the Low fibrosis-4 group, respectively (P<0.001). Worse disease-free survival was also observed in the fibrosis-4 ⩾3.15 group; the corresponding 1-year, 3-year, and 5-year disease-free survival were 74.9%, 45.3%, and 24.6% for the fibrosis-4 ⩾3.15 group and were 81.8%, 54.9%, and 34.4% for the fibrosis-4<3.15 group (P=0.009). Conclusions Fibrosis-4 is useful for assessing the short-term and long-term results for hepatocellular carcinoma patients with liver resection.

Immunological characterization of hepatocellular carcinoma

“…The degree of liver fibrosis can be estimated using the fibrosis-4 (FIB-4) index, which takes into account the patient's age, AST, ALT, and platelet count [162] . Several studies have demonstrated that higher FIB-4 score is associated with worse outcomes, including increased risk of developing HCC in setting of chronic HCV infection and increased persistence of HCC post-hepatectomy [163][164][165] . Fibrosis evidently influences clinical outcomes in HCC.…”

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

“…Over the years, several studies have validated its role as a marker of hepatic fibrosis [18,19] . An important study [20] indicated that the Fib-4 index not only demonstrated the best predictive ability for cirrhosis, but it was also an independent prognostic factor for postoperative hepatic insufficiency, overall survival, and disease-free survival for HCC patients with radical liver resection. They also stratified patients, with the cut-off value of 3.15, into Low and High fibrosis-4 groups.…”