Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Chinese Medicine, China Medical University, Taichung, Taiwan.
J Gastroenterol Hepatol. 2019 Feb;34(2):442-449. doi: 10.1111/jgh.14372. Epub 2018 Jul 19.
Noninvasive fibrosis indices can predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Modified FIB-4 (mFIB-4) is a promising noninvasive index for predicting liver fibrosis. To investigate the predictive accuracy of several extant noninvasive fibrosis indices, including mFIB-4, for HCC incidence in CHB patients receiving long-term entecavir therapy.
We enrolled 1325 nucleos(t)ide analogue-naïve CHB patients (noncirrhotic 844; cirrhotic 481) treated with entecavir. Baseline clinical features and fibrosis indices were collected and evaluated for predicting HCC risk through univariate and multivariate Cox regression analyses.
Of the 1325 patients, 105 (7.9%) developed HCC during a median follow-up period of 4.1 years. Age (hazard ratio [HR], 1.039; 95% confidence interval [CI], 1.020-1.059; P < 0.0001), diabetes mellitus (DM) (HR, 1.902; 95% CI, 1.185-3.052; P = 0.0077), and mFIB-4 (HR, 4.619; 95% CI, 1.810-11.789; P = 0.0014) were independent predictors of HCC in all patients (mFIB-4 ≥ 1.5 for the noncirrhotic cohort; DM and mFIB-4 ≥ 2.0 for the cirrhotic cohort). A combination of mFIB-4 and the DM status stratified the cumulative risk of HCC into three subgroups in all patients (high: mFIB-4 ≥ 1.5/DM; intermediate: mFIB-4 ≥ 1.5/non-DM; and low: mFIB-4 < 1.5, P < 0.0001) and in the cirrhotic cohort (high: mFIB-4 ≥ 2.0/DM; intermediate: mFIB-4 ≥ 2.0/non-DM; and low: mFIB-4 < 2.0, P = 0.0007). An mFIB-4 cutoff value of 1.5 stratified the cumulative risk of HCC in the noncirrhotic cohort (P = 0.015).
The mFIB-4 index alone or in combination with DM is the optimal noninvasive predictor of HCC risk in CHB patients receiving entecavir therapy.
非侵入性纤维化指数可预测乙型肝炎慢性患者（CHB）发生肝细胞癌（HCC）的风险。改良 FIB-4（mFIB-4）是一种有前途的预测肝纤维化的非侵入性指数。本研究旨在探讨几种现有的非侵入性纤维化指数，包括 mFIB-4，对接受长期恩替卡韦治疗的 CHB 患者 HCC 发生率的预测准确性。
我们纳入了 1325 名未经核苷（酸）类似物治疗的 CHB 患者（非肝硬化 844 例；肝硬化 481 例），接受恩替卡韦治疗。收集基线临床特征和纤维化指数，通过单因素和多因素 Cox 回归分析评估预测 HCC 风险的能力。
在中位随访 4.1 年期间，1325 例患者中有 105 例（7.9%）发生 HCC。年龄（风险比[HR]，1.039；95%置信区间[CI]，1.020-1.059；P<0.0001）、糖尿病（DM）（HR，1.902；95%CI，1.185-3.052；P=0.0077）和 mFIB-4（HR，4.619；95%CI，1.810-11.789；P=0.0014）是所有患者发生 HCC 的独立预测因素（非肝硬化组 mFIB-4≥1.5；肝硬化组 DM 和 mFIB-4≥2.0）。mFIB-4 和 DM 状态的组合将所有患者的 HCC 累积风险分为三个亚组（高：mFIB-4≥1.5/DM；中：mFIB-4≥1.5/非-DM；低：mFIB-4<1.5，P<0.0001）和肝硬化组（高：mFIB-4≥2.0/DM；中：mFIB-4≥2.0/非-DM；低：mFIB-4<2.0，P=0.0007）。mFIB-4 的截断值为 1.5 时，可将非肝硬化组的 HCC 累积风险分层（P=0.015）。
mFIB-4 指数单独或与 DM 联合是预测接受恩替卡韦治疗的 CHB 患者 HCC 风险的最佳非侵入性指标。
