Tan Darren Jun Hao, Tamaki Nobuharu, Kim Beom Kyung, Wijarnpreecha Karn, Aboona Majd Bassam, Faulkner Claire, Kench Charlotte, Salimi Shirin, Sabih Abdul-Hamid, Lim Wen Hui, Danpanichkul Pojsakorn, Tay Benjamin, Teh Yiqing, Mok John, Nah Benjamin, Ng Cheng Han, Muthiah Mark, Kulkarni Anand V, Lee Sung Won, Liu Ken, Loomba Rohit, Huang Daniel Q
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
Aliment Pharmacol Ther. 2025 Jan;61(2):278-285. doi: 10.1111/apt.18346. Epub 2024 Oct 27.
Major society guidelines recommend the fibrosis-4 index (FIB-4) as the initial step to risk stratifying people with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to evaluate the proportion of people with MASLD-related hepatocellular carcinoma (HCC) and a low FIB-4.
This cohort study included 613 consecutive adults (33% female) diagnosed with MASLD-related HCC from January 2008 to August 2023 at seven international centres in Australia, India, Japan, South Korea, Singapore and the United States. The primary objective was to determine the proportion of participants with a low FIB-4, defined as FIB-4 < 1.3, or < 2 if age > 65 years, in people without cirrhosis.
The mean (±SD) age and body mass index were 71 (±11) years and 27 (±7) kg/m, respectively. Overall, 235 participants (38%) did not have known cirrhosis. The median FIB-4 was 3.90 (IQR 2.42-6.42). A total of 78 participants (13%) had a low FIB-4. Among participants without known cirrhosis (n = 235), 62 participants (26%) had a low FIB-4. Participants with a low FIB-4 had larger median total tumour diameter (p < 0.001) and lower median serum alpha-fetoprotein (p = 0.005), compared to participants without a low FIB-4. Cirrhosis was associated with lower odds of low FIB-4, but not other factors such as male sex, type 2 diabetes, or obesity.
More than a quarter of those with MASLD-related HCC without cirrhosis have a low FIB-4. The proposed clinical care pathways may not identify these people for further evaluation.
主要社会指南推荐使用纤维化-4指数（FIB-4）作为对代谢功能障碍相关脂肪性肝病（MASLD）患者进行风险分层的第一步。我们旨在评估患有MASLD相关肝细胞癌（HCC）且FIB-4较低的患者比例。
这项队列研究纳入了2008年1月至2023年8月期间在澳大利亚、印度、日本、韩国、新加坡和美国的七个国际中心连续诊断为MASLD相关HCC的613名成年人（33%为女性）。主要目标是确定在无肝硬化的患者中，FIB-4较低（定义为FIB-4＜1.3，或年龄＞65岁时FIB-4＜2）的参与者比例。
平均（±标准差）年龄和体重指数分别为71（±11）岁和27（±7）kg/m²。总体而言，235名参与者（38%）没有已知的肝硬化。FIB-4的中位数为3.90（四分位间距2.42 - 6.42）。共有78名参与者（13%）的FIB-4较低。在无已知肝硬化的参与者（n = 235）中，62名参与者（26%）的FIB-4较低。与FIB-4不低的参与者相比，FIB-4较低的参与者的总肿瘤直径中位数更大（p＜0.001），血清甲胎蛋白中位数更低（p = 0.005）。肝硬化与FIB-4较低的几率较低相关，但与其他因素如男性、2型糖尿病或肥胖无关。
超过四分之一的无肝硬化的MASLD相关HCC患者FIB-4较低。拟议的临床护理路径可能无法识别这些患者进行进一步评估。
