Nishikawa Hiroki, Osaki Yukio, Komekado Hideyuki, Sakamoto Azusa, Saito Sumio, Nishijima Norihiro, Nasu Akihiro, Arimoto Akira, Kita Ryuichi, Kimura Toru
Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan.
Department of Surgery, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan.
Oncol Rep. 2015 Jan;33(1):88-94. doi: 10.3892/or.2014.3573. Epub 2014 Oct 30.
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/m2. 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.
本研究的目的是探讨手术标本中非肿瘤部分术前FIB-4指数与背景肝纤维化之间的关系，并研究FIB-4指数是否可作为接受手术切除（SR）治疗的非B非C型肝细胞癌（NBNC-HCC）患者的有用预测指标。对118例接受根治性SR治疗的NBNC-HCC患者进行了分析。进行了受试者操作特征（ROC）曲线分析，以计算FIB-4指数、天冬氨酸转氨酶（AST）与血小板比值指数、AST与丙氨酸转氨酶比值、血清白蛋白、总胆红素和血小板计数用于肝硬化诊断时的ROC曲线下面积（AUROC）。我们还研究了与SR术后总生存期（OS）和无复发生存期（RFS）相关的预测因素。患者的平均年龄为68.9±9.0岁（男性93例，女性25例），中位观察期为3.2年。在提取的手术标本中，39例患者（33.1%）观察到背景肝硬化（F4）。平均最大肿瘤大小为5.7±3.2 cm。平均体重指数为24.3±3.9 kg/m2。FIB-4指数在诊断肝硬化时的AUROC最高，在最佳临界值为2.97时为0.887（敏感性为92.3；特异性为69.6%）。在多变量分析中，血清甲胎蛋白>40 ng/ml（P=0.026）是与OS相关的唯一显著独立预测因素，而肿瘤数量（P=0.002）和FIB-4指数>2.97（P=0.044）是与RFS相关的显著因素。总之，术前FIB-4指数可作为接受SR治疗的NBNC-HCC患者的有用预测指标。
