High liver fibrosis index FIB‐4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers

Abstract

Screening for hepatocellular carcinoma (HCC) is clinically important given that its early detection has remarkable survival benefits. We investigated the possible role of FIB-4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers 40 years of age or older who visited Seoul National University Hospital for a health checkup. National medical service claims data were used to determine HCC incidence. Median follow-up time was 5.4 years (interquartile range: 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and antiviral medication for hepatitis B, compared to subjects with FIB-4 <1.25, subjects with 1.7 £ FIB-4 <2.4 showed an adjusted hazard ratio (aHR) of 4.57 (95% confidence interval [CI]: 1.50-13.92) and subjects with FIB-4 2.4 showed an aHR of 21.34 (95% CI: 7.73-58.92) for HCC incidence. FIB-4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C-index: 0.701 vs. 0.831; P 5 0.001). FIB-4 was also better predictive of HCC incidence, compared to that of ultrasonographic liver cirrhosis (C-index: 0.775 vs. 0.701; P 5 0.040). Conclusion: High FIB-4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB-4 is a promising, easily applicable, and cost-effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests that FIB-4 may play a valuable role in HCC screening among HBsAg carriers. (HEPATOLOGY 2015;61:1261-1268 L iver cancer is the fifth-most frequently diagnosed cancer worldwide in men, also the secondleading cause of cancer mortality in the world. 1 For females, it is the seventh-most common cancer and sixth-leading cause of cancer mortality. 1 Liver cancer incidence is increasing in many parts of the world, including in the United States and Europe. 2,3 In Korea, liver cancer represents the second-highest cause of cancer mortality and is the fifth-most frequently diagnosed cancer. 4 Despite such high incidence and mortality, major risk factors for liver cancer are well established as chronic hepatitis and cirrhosis, 5 similarly in Korea where liver cancer has been attributed to chronic hepatitis B (CHB), C, or cirrhosis in 95% of

Clinical Significance of Preoperative Liver Stiffness Measurements in Primary HBV-Positive Hepatocellular Carcinoma

“…It has been revealed that there is a significant role of liver fibrosis on progression and metastasis of HCC, especially for patients who had comorbidity of HBV infection [20][21][22]. In the current study, we found the preoperative LSM value measured though FibroScan was an independent prognostic factor for HBV-related HCC patients.…”

Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection

“…A cut-off value ≤1.45 could differentiate moderate from severe fibrosis with an NPV of 86%, a sensitivity of 71% and a specificity of 73%. A 2014 meta-analysis examined the value of the FIB-4 index (42,43). In clinical practice, the low cut-off of FIB-4 at 1.45 can be used to rule out patients without advanced fibrosis, hence it can be used as a triaging test (4).…”

Evaluation of FIB-4 Index as a Marker for Hepatocellular Carcinoma in HIV - Hepatitis C Co-Infection

“…Subsequent studies also reported FIB-4 to be a strong indicator of liver cirrhosis [8,9]. Suh et al reported that in patients with chronic hepatitis B infection, high FIB-4 scores of >2.4 correlated with hepatocellular carcinoma incidence [10]. High FIB-4 was shown to be a strong predictor and risk factor for hepatocellular carcinoma in HIV-infected patients [6].…”