Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma

Hung, Hung Hsu; Su, Chien Wei; Lai, Chiung Ru; Chau, Gar Yang; Chan, Che Chang; Huang, Yi Hsiang; Huo, Teh Ia; Lee, Pui Ching; Kao, Wei Yu; Lee, Shou Dong; Wu, Jaw Ching

doi:10.1007/s12072-010-9213-3

Cited by 62 publications

(76 citation statements)

References 28 publications

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“…Serum markers and developed scores are of rising significance in noninvasive diagnosis of liver fibrosis owing to the easy availability in field practice. Among these tools, the FIB-4 index is a simple formula used for predicting liver fibrosis based on standard biochemical values (platelet count, AST and ALT) and age, and is demonstrated to be highly helpful for predicting advanced liver fibrosis (19)(20)(21)(22) (23,24). The aims of the present study were to examine the relationship between preoperative FIB-4 index and background liver fibrosis in non-tumor parts obtained from extracted surgical specimens and to investigate whether the preoperative FIB-4 index can be a useful predictor for NBNC-HCC patients treated with SR.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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...

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Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…In a meta-analysis performed by Poynard et al (23), the AUC value from the FibroTest was reported to be 0.84. The APRI score is the most frequently studied formulation regarding routine laboratory tests (4,24). The APRI score, which was recommended for the first time for patients with CHC and yielded significant results in the prediction of significant fibrosis and cirrhosis, resulted in disappointing effects for patients with CHB.…”

Section: Discussionmentioning

confidence: 99%

“…Although some formulations with high AUC values between fibrosis stage and hyaluronic acid, apolipoprotein A1, and α2-macroglobulin in patients with CHB have been suggested in previous studies, these formulations are not extensively used. As the aforementioned markers of fibrosis are not routinely used and are not easily accessible, they are not cost-effective (19,4).…”

Section: Discussionmentioning

confidence: 99%

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Routinely evaluated clinical assays and laboratory tests [real test] and fibrosis stages of chronic hepatitis B and C

Bugdaci

Korkmaz²,

Demir³

et al. 2014

Turk J Gastroenterol

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Background/Aims: To provide a new mathematical formula to predict liver fibrosis in patients with chronic viral hepatitis. Materials and Methods: Patients with chronic hepatitis B and C who underwent liver biopsy at different centers were included in this study. Chronic hepatitis B was defined as immunopositivity for the hepatitis B surface antigen for at least 6 months, and chronic hepatitis C was defined as positivity for HCV RNA for at least 3 months. The histological features were evaluated by the histological activity index and fibrosis. Results: In total, 1299 patients were included in the study. The distribution and the mean of the parameters of the patients were as follows: 1009 patients with chronic hepatitis B with a mean age of 45±13/years [emale/male (F/M)=47.5/52.5%] and 290 patients with hepatitis C with a mean age of 52±10.3/years [F/M=61/39%]. When the cut-off value of the REAL TEST formula"[(age x pT x AST)/(PLT/1000)]/100" in patients with hepatitis B was determined to be ≥1.37, it was found that it could predict fibrosis with 79% specificity, 78% sensitivity, 85% negative predictive value (NPV), and 70% positive predictive value (PPV) (area under the curve (AUC)=0.852, 95% CI:0.82-0.87). When the cut-off value of the REAL TEST formula in patients with hepatitis C was determined to be ≥1.99, it was found that it could predict significant fibrosis with 87% specificity, 90% sensitivity, 94.4% NPV, and 79.4% PPV (AUC:0.95, 95% CI:0.93-0.98) Conclusion: The REAL TEST formula results correlated with the pathological findings and may be a useful method for the evaluation of patients with chronic hepatitis B and C.

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“…[5][6][7][8] Background liver inflammation and fibrosis play critical roles in the process of hepatocarcinogenesis and survival after hepatectomy. [9][10][11] Few studies have aimed to assess the prognostic potential of these and other factors comprehensively and systematically. Research has tended to focus on candidate prognostic markers that can be screened less invasively than by the gold-standard technique of liver biopsy, which is costly and carries a risk of pain, bleeding, and bile duct injury.…”

Section: Introductionmentioning

confidence: 99%

Stratified aspartate aminotransferase-to-platelet ratio index accurately predicts survival in hepatocellular carcinoma patients undergoing curative liver resection

et al. 2017

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The aspartate aminotransferase-to-platelet ratio index has been reported to predict prognosis of patients with hepatocellular carcinoma. This study examined the prognostic potential of stratified aspartate aminotransferaseto-platelet ratio index for hepatocellular carcinoma patients undergoing curative liver resection. A total of 661 hepatocellular carcinoma patients were retrieved and the associations between aspartate aminotransferase-toplatelet ratio index and clinicopathological variables and survivals (overall survival and disease-free survival) were analyzed. Higher aspartate aminotransferase-to-platelet ratio index quartiles were significantly associated with poorer overall survival (p = 0.002) and disease-free survival (p = 0.001). Multivariate analysis showed aspartate aminotransferase-to-platelet ratio index to be an independent risk factor for overall survival (p = 0.018) and diseasefree survival (p = 0.01).Patients in the highest aspartate aminotransferase-to-platelet ratio index quartile were at 44% greater risk of death than patients in the first quartile (hazard ratio = 1.445, 95% confidence interval = 1.081 -1.931, p = 0.013), as well as 49% greater risk of recurrence (hazard ratio = 1.49, 95% confidence interval = 1.112-1.998, p = 0.008). Subgroup analysis also showed aspartate aminotransferase-to-platelet ratio index to be an independent predictor of poor overall survival and disease-free survival in patients positive for hepatitis B surface antigen or with cirrhosis (both p < 0.05). Similar results were obtained when aspartate aminotransferase-to-platelet ratio index was analyzed as a dichotomous variable with cutoff values of 0.25 and 0.62. Elevated preoperative aspartate aminotransferase-to-platelet ratio index may be independently associated with poor overall survival and disease-free survival in hepatocellular carcinoma patients following curative resection.

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Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma

Cited by 62 publications

References 28 publications

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

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

Routinely evaluated clinical assays and laboratory tests [real test] and fibrosis stages of chronic hepatitis B and C

Stratified aspartate aminotransferase-to-platelet ratio index accurately predicts survival in hepatocellular carcinoma patients undergoing curative liver resection

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