Okamura Yukiyasu, Ashida Ryo, Yamamoto Yusuke, Ito Takaaki, Sugiura Teiichi, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Ann Surg Oncol. 2016 Aug;23(Suppl 4):467-474. doi: 10.1245/s10434-016-5377-y. Epub 2016 Jun 30.
The FIB-4 index is a simple formula for predicting the degree of liver fibrosis. This study aimed to examine the relationship between the preoperative FIB-4 index and liver fibrosis in non-tumor regions of surgical specimens and to investigate whether the FIB-4 index is a useful predictor for long-term outcomes experienced by hepatocellular carcinoma (HCC) patients after curative resection.
This study retrospectively analyzed 493 HCC patients treated with curative resection. The utility of the FIB-4 index as a predictor of advanced liver fibrosis (F3 or F4) was assessed. The cutoff value for the FIB-4 index was determined using a receiver operating characteristic curve analysis, and the impact of the FIB-4 index on overall and recurrence-free survival after surgery was evaluated.
Advanced liver fibrosis was found in 236 patients (47.9 %). The FIB-4 index was significantly higher for the patients with advanced liver fibrosis than for those without this condition (P < 0.001). An FIB-4 index of 2.87 was the optimal cutoff point for predicting advanced liver fibrosis. The multivariate analysis showed the FIB-4 index to be an independent prognostic factor for recurrence-free and overall survival after curative resection only for patients who underwent hepatectomy as initial treatment (hazard ratio, 1.47 and 1.59; 95 % confidence interval, 1.12-1.93 and 1.09-2.32; P = 0.006 and 0.016, respectively).
The study showed the FIB4-index to be a predictor of background liver fibrosis and long-term outcomes for HCC patients who underwent hepatectomy as their initial treatment.
FIB-4指数是一种预测肝纤维化程度的简单公式。本研究旨在探讨术前FIB-4指数与手术标本非肿瘤区域肝纤维化之间的关系，并研究FIB-4指数是否可作为肝细胞癌（HCC）患者根治性切除术后长期预后的有用预测指标。
本研究回顾性分析了493例行根治性切除的HCC患者。评估了FIB-4指数作为晚期肝纤维化（F3或F4）预测指标的效用。使用受试者工作特征曲线分析确定FIB-4指数的临界值，并评估FIB-4指数对术后总生存和无复发生存的影响。
236例患者（47.9%）存在晚期肝纤维化。晚期肝纤维化患者的FIB-4指数显著高于无此情况的患者（P<0.001）。FIB-4指数为2.87是预测晚期肝纤维化的最佳临界点。多因素分析显示，仅对于以肝切除术作为初始治疗的患者，FIB-4指数是根治性切除术后无复发生存和总生存的独立预后因素（风险比分别为1.47和1.59；95%置信区间分别为1.12-1.93和1.09-2.32；P分别为0.006和0.016）。
该研究表明，FIB4指数可作为以肝切除术作为初始治疗的HCC患者背景肝纤维化及长期预后的预测指标。
