Department of Internal Medicine, CHA Bundang Medical Center, CHA Univesity, Seongnam, Republic of Korea.
Eur J Gastroenterol Hepatol. 2020 Mar;32(3):433-439. doi: 10.1097/MEG.0000000000001520.
It is well known that hepatocellular carcinoma (HCC) develops as a consequence of hepatic fibrosis progression. Thus, early identification of advanced liver fibrosis is very important. This study evaluated the prognostic value of FIB-4, the aspartate transaminase to-platelet ratio index (APRI), and the gamma-glutamyl transpeptidase-toplatelet ratio (GPR) for predicting HCC development using histological fibrosis stage as a reference in Asian chronic hepatitis B (CHB) patients.
A total of 444 CHB patients who underwent liver biopsy and serological tests for determining noninvasive serum fibrosis markers were enrolled. All patients were followed to monitor HCC development.
The histological fibrosis stage showed best performance in predicting HCC development at 5 (area under the receiver operating characteristic curve [AUROC] = 0.783) and 7 years (AUROC = 0.766), followed by FIB-4 (AUROC = 0.753 at 5 years, 0.698 at 7 years), APRI (AUROC = 0.658 at 5 years, 0.572 at 7 years), and GPR (AUROC = 0.638 at 5 years, 0.603 at 7 years). When we classified risk groups according to the histological fibrosis stage (F4 vs. F0-3) and FIB-4 (FIB-4 ≥ 3.25 vs. FIB-4 < 3.25), patients in the high-risk group were found to have a significantly higher probability of developing HCC than those in the low-risk group (P=0.005 and 0.022, respectively, log-rank test).
Our study demonstrated that FIB-4 is useful for the noninvasive prediction of HCC development, while APRI and GPR were less useful.
众所周知，肝细胞癌（HCC）是肝纤维化进展的结果。因此，早期识别晚期肝纤维化非常重要。本研究评估了 FIB-4、天门冬氨酸氨基转移酶与血小板比值指数（APRI）和γ-谷氨酰转肽酶与血小板比值（GPR）在预测亚洲慢性乙型肝炎（CHB）患者 HCC 发展中的预后价值，以组织学纤维化分期作为参考。
共纳入 444 例接受肝活检和血清学检查以确定非侵入性血清纤维化标志物的 CHB 患者。所有患者均接受随访以监测 HCC 发展情况。
组织学纤维化分期在预测 HCC 发展方面表现最佳，在 5 年（接受者操作特征曲线下面积 [AUROC] = 0.783）和 7 年（AUROC = 0.766）时表现最佳，其次是 FIB-4（5 年时 AUROC = 0.753，7 年时 AUROC = 0.698）、APRI（5 年时 AUROC = 0.658，7 年时 AUROC = 0.572）和 GPR（5 年时 AUROC = 0.638，7 年时 AUROC = 0.603）。当我们根据组织学纤维化分期（F4 与 F0-3）和 FIB-4（FIB-4≥3.25 与 FIB-4<3.25）对风险组进行分类时，发现高危组患者发生 HCC 的概率明显高于低危组（P=0.005 和 0.022，log-rank 检验）。
本研究表明 FIB-4 可用于 HCC 发展的无创预测，而 APRI 和 GPR 的作用则较小。
