Abstract
The Ishak scoring system has been used to stage liver fibrosis. Ten noninvasive liver reserve models were proposed to assess the severity of liver fibrosis, but their performance in hepatocellular carcinoma (HCC) is unknown. We aimed to evaluate the correlation between these models and severity of fibrosis in patients with HCC. A total 464 patients with HCC undergoing surgical resection were retrospectively analyzed. Multivariate logistic regression analysis was performed to determine independent factors associated with advanced fibrosis (Ishak score 4 or higher). There were no significant correlations between all noninvasive models and severity of fibrosis in HCC (p for trend all >0.1). In subgroup analysis, cirrhosis discriminant index (CDS) and Lok’s index in hepatitis B-, and fibrosis index based on 4 factors (FIB-4), CDS and Lok’s index in hepatitis C-associated HCC, best correlated with the severity of liver fibrosis. Low platelet count, prolonged prothrombin time, hepatitis C and multiple tumors were independently associated with advanced fibrosis. Among the 10 models, CDS was the best model to predict cirrhosis. Currently used noninvasive liver reserve models do not well correlate with severity of histological fibrosis in HCC. New noninvasive models are required to improve the predictive accuracy of liver fibrosis in HCC.
Highlights
Hepatocellular carcinoma (HCC) is a common primary liver cancer worldwide with a rising incidence rate[1,2]
The CTP and model for end-stage liver disease (MELD) scoring system are widely used in patients with liver diseases, these models are not optimal for evaluating liver fibrosis
Noninvasive liver reserve models were proposed to assess the severity of liver fibrosis mainly in patients with chronic hepatitis B or C18,23,25,28,38–40
Summary
Hepatocellular carcinoma (HCC) is a common primary liver cancer worldwide with a rising incidence rate[1,2]. Liver biopsy is the standard method to assess liver fibrosis It is an invasive procedure with potentially serious complications that preclude its wide implementation in daily practice. Albumin-bilirubin (ALBI) grade and the platelet-albumin-bilirubin (PABLI) grade were proposed to evaluate the severity of liver fibrosis in HCC30,31. With all these choices, no study to date has evaluated the relationship and accuracy between noninvasive liver reserve models and the severity of liver fibrosis in HCC. We aimed to investigate the correlation of the currently used noninvasive liver function models and histological fibrosis in HCC patients undergoing surgical resection
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