Armandi Angelo, Caviglia Gian Paolo, Abdulle Amina, Rosso Chiara, Gjini Kamela, Castelnuovo Gabriele, Guariglia Marta, Perez Diaz Del Campo Nuria, D'Amato Daphne, Ribaldone Davide Giuseppe, Saracco Giorgio Maria, Bugianesi Elisabetta
Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
Metabolic Liver Disease Research Program, University Medical Center, Department of Internal Medicine I, Johannes Gutenberg University, 55131 Mainz, Germany.
Cancers (Basel). 2023 Mar 8;15(6):1659. doi: 10.3390/cancers15061659.
Hepatocellular carcinoma (HCC) represents a relevant disease burden in cirrhotic patients with non-alcoholic fatty liver disease (NAFLD). We aimed to investigate the prognostic value of simple non-invasive tests (NITs) (AAR, APRI, BARD, FIB-4) for the stratification of HCC risk development in a cohort of 122 consecutive cirrhotic individuals with NAFLD. Over a median follow up of 5.9 (3.2-9.3) years, 13 (10.7%) developed HCC. Only FIB-4 was associated with HCC risk (HR = 1.27, 95% CI 1.03-1.58, = 0.027). After evaluating different established FIB-4 cut-offs, the lowest cut-off of 1.45 allowed the ruling out of a greater number of patients with a minimal risk of HCC than the 1.3 cut-off (23 vs. 18 patients). Conversely, the cumulative incidence of HCC using the highest cut-off of 3.25 (rule in) was distinctly higher than the 2.67 cut-off (19.4% vs. 13.3%). After multivariate Cox regression analysis, these cut-offs were independently associated with HCC after adjusting for sex, BMI and T2DM (HR = 6.40, 95% CI 1.71-24.00, = 0.006). In conclusion, FIB-4 values of <1.3 and >3.25 could allow for the optimal stratification of long-term HCC risk in cirrhotic individuals with NAFLD.
肝细胞癌（HCC）是患有非酒精性脂肪性肝病（NAFLD）的肝硬化患者的一项重要疾病负担。我们旨在研究简单非侵入性检测（NITs）（天冬氨酸氨基转移酶与血小板比值指数[AAR]、天冬氨酸氨基转移酶与血小板比值[APRI]、BARD、FIB-4）对122例连续的患有NAFLD的肝硬化个体队列中HCC风险发展分层的预后价值。在中位随访5.9（3.2 - 9.3）年期间，13例（10.7%）发生了HCC。只有FIB-4与HCC风险相关（风险比[HR]=1.27，95%置信区间[CI]为1.03 - 1.58，P = 0.027）。在评估不同的既定FIB-4临界值后，最低临界值1.45比临界值1.3能排除更多HCC风险极小的患者（分别为23例和18例患者）。相反，使用最高临界值3.25（纳入标准）时HCC的累积发病率明显高于临界值2.67（分别为19.4%和13.3%）。经过多变量Cox回归分析，在调整性别、体重指数（BMI）和2型糖尿病（T2DM）后，这些临界值与HCC独立相关（HR = 6.40，95% CI为1.71 - 24.00，P = 0.006）。总之，FIB-4值<1.3和>3.25可实现对患有NAFLD的肝硬化个体长期HCC风险的最佳分层。
