Imaoka Yuki, Ohira Masahiro, Kobayashi Tsuyoshi, Honmyo Naruhiko, Hamaoka Michinori, Onoe Takashi, Takei Daisuke, Oishi Koichi, Abe Tomoyuki, Nakayama Toshihiro, Akabane Miho, Sasaki Kazunari, Ohdan Hideki
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima University Hiroshima Japan.
Division of Abdominal Transplant Stanford University Stanford California USA.
Ann Gastroenterol Surg. 2025 Apr 13;9(5):1055-1065. doi: 10.1002/ags3.70010. eCollection 2025 Sep.
Liver fibrosis is a key factor in the progression of chronic liver diseases, including viral hepatitis and metabolic dysfunction-associated steatotic liver disease. If untreated, fibrosis can progress to cirrhosis, increasing the risk of liver cancer or failure. This study evaluates the Fibrosis (FIB)-3 index, a novel marker free from age-related biases, for predicting liver fibrosis and 5-year outcomes in hepatocellular carcinoma (HCC) patients undergoing hepatectomy.
Data from 1013 patients who underwent liver resection were analyzed in this multi-institutional study. The predictive performance of the FIB-3 index was compared with the original FIB-4 index, which incorporates age into its calculation.
The FIB-3 index demonstrated superior accuracy for advanced fibrosis (≥F3) in elderly patients. A higher FIB-3 index was an independent risk factor for recurrence-free survival in elderly patients, underscoring its utility in this population. Notably, the application of appropriate cutoff values allowed the FIB-3 index to facilitate effective risk stratification for 5-year overall survival and recurrence-free survival.
The FIB-3 index served as an effective alternative to the FIB-4 index in assessing liver fibrosis among aged patients, and it effectively stratified the likelihood of the 5-year outcomes when utilized in conjunction with a specific cut-off after initial hepatectomy for HCC.
肝纤维化是慢性肝病进展的关键因素，包括病毒性肝炎和代谢功能障碍相关脂肪性肝病。若不治疗，纤维化可进展为肝硬化，增加肝癌或肝衰竭风险。本研究评估纤维化（FIB）-3指数，这是一种无年龄相关偏倚的新型标志物，用于预测接受肝切除术的肝细胞癌（HCC）患者的肝纤维化及5年预后。
在这项多机构研究中分析了1013例行肝切除术患者的数据。将FIB-3指数的预测性能与原始FIB-4指数进行比较，后者在计算中纳入了年龄因素。
FIB-3指数在老年患者中对晚期纤维化（≥F3）显示出更高的准确性。较高的FIB-3指数是老年患者无复发生存的独立危险因素，突出了其在该人群中的实用性。值得注意的是，应用适当的临界值可使FIB-3指数有助于对5年总生存和无复发生存进行有效的风险分层。
FIB-3指数在评估老年患者肝纤维化方面可作为FIB-4指数的有效替代指标，并且在HCC初次肝切除术后结合特定临界值使用时，能有效分层5年预后的可能性。
