A novel, non-invasive model for diagnosing liver fibrosis stage in patients with hepatocellular carcinoma

Gao-Xiong Ouyang,Bang-De Xiang,Zhi-Ming Zhang,Jun Chen,Le-Qun Li,Yu-Kai Liu,Yuan Ren,Peng Wang,Jian-Yong Liu,Yu-Mei Zhang,Shao-Liang Zhu,Jia-Hao Li

doi:10.1038/s41598-018-31351-3

Abstract

The aim of this study was to investigate the diagnostic value of the platelet count-to-spleen volume ratio (PSR) for diagnosing hepatic fibrosis in patients with hepatocellular carcinoma (HCC). In this interim analysis of an on-going prospective study, 117 patients with HCC and with or without cirrhosis or fibrosis in different stages were analyzed. Fibrosis staging negatively correlated with PSR and the liver volume-to-spleen volume ratio (LSR), while it positively correlated with aspartate aminotransferase-to-platelet ratio index (APRI), Frons’ index, S-index and a fibrosis index based on four factors (FIB-4). The area under the receiver operating characteristic curve (AUROC) was significantly larger for PSR (0.777) than LSR (0.633, P = 0.002). Among patients with significant fibrosis, AUROC for PSR did not differ significantly from the AUROCs for APRI (0.789, P = 0.825), Frons’ index (0.674, P = 0.102), FIB-4 (0.704, P = 0.251) or S-index (0.696, P = 0.204). Among patients with severe fibrosis, AUROC was significantly higher for PSR (0.808) than for LSR (0.685, P = 0.003), Frons’ index (0.673, P = 0.014), FIB-4 (0.684, P = 0.029), or S-index (0.672, P = 0.016); in contrast, the AUROC for PSR was not significantly different from that for APRI (0.739, P = 0.215). Among patients with cirrhosis, AUROC was significantly higher for PSR (0.814) than for LSR (0.671, P = 0.001) or S-index (0.679, P = 0.022), while the AUROC for PSR did not differ significantly from those for APRI (0.711, P = 0.105), Frons’ index (0.722, P = 0.061) or FIB-4 (0.708, P = 0.079). Our results suggest that PSR may be a useful non-invasive model for diagnosing liver fibrosis stage in patients with HCC in China.

Highlights

The gold standard for diagnosing and staging hepatic fibrosis is liver biopsy, but biopsy is rarely used because of its invasiveness and complications
Fibrosis staging negatively correlated with platelet count-to-spleen volume ratio (PSR) (r = −0.577) and liver-to-spleen volume ratio (LSR) (r = −0.312), while it positively correlated with aspartate transaminase-to-platelet ratio index (APRI) (r = 0.476), Frons’ index (r = 0.366), FIB-4 (r = 0.384) and S-index (r = 0.353)
The main cause of perioperative death is postoperative liver failure, which is associated with degree of hepatitis or cirrhosis in many Hepatocellular carcinoma (HCC) patients in China

Summary

Introduction

The gold standard for diagnosing and staging hepatic fibrosis is liver biopsy, but biopsy is rarely used because of its invasiveness and complications. The accuracy of liver biopsy is severely compromised by intra- and inter-observer variation as well as sampling error[3,4,5] This has led several studies to explore non-invasive models for diagnosing different stages of hepatic fibrosis[6,7,8,9]. These models include the aspartate transaminase-to-platelet ratio index (APRI), Frons’ index, and a fibrosis index based on four factors (FIB-4). We defined the platelet count-to-spleen volume ratio (PSR) as a novel, non-invasive fibrosis model and assessed its ability to diagnose liver fibrosis stage in HCC patients. Our results suggest that PSR, which can be calculated more than other models, may be more accurate for diagnosing hepatic fibrosis stage in HCC and more effective at guiding hepatectomy

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