Abstract
Background and aimsFibrosis-4 (FIB-4) index is a HCC predictor in chronic hepatitis B (CHB) patients. However, little is known about whether FIB-4 helps identify non-cirrhotic CHB patients with minimal HCC risk after prolonged nucleos(t)ide analogue (NA) therapy.MethodsA total of 1936 ethnically diverse, non-cirrhotic CHB patients were enrolled in this retrospective multi-national study. All patients received prolonged NA treatment, including entecavir and tenofovir disoproxil fumarate. We explored whether FIB-4 cutoff of 1.30, a marker indicative of mild fibrosis severity, could stratify HCC risks in these patients.ResultsA total of 48 patients developed HCC after a mean follow-up of 6.98 years. FIB-4 level at 1 year after treatment (1-year FIB-4) was shown to be associated with HCC development and was superior to pre-treatment FIB-4 value. When patients were stratified by 1-year FIB-4 of 1.30, the high FIB-4 group was at an increased HCC risk compared to the low FIB-4 group, with a hazard ratio of 4.87 (95% confidence interval: 2.48–9.55). Multivariable analysis showed that sex and 1-year FIB-4 were independent predictors, with none of the 314 female patients with low 1-year FIB-4 developing HCC. Finally, 1-year FIB-4 of 1.30 consistently stratified HCC risks in patients with low PAGE-B score, a score composed of baseline age, sex and platelet count, and the annual incidence rate of HCC was 0.11% in those with PAGE-B < 10 + 1-year FIB-4 < 1.30.ConclusionsIn non-cirrhotic CHB patients receiving prolonged NA therapy, 1-year FIB-4 < 1.30 is useful for identifying those with minimal HCC risk by combining with female sex or low PAGE-B score.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12072-020-10124-z.
Highlights
We investigated whether FIB-4 < 1.30 could help identify patients with minimal hepatocellular carcinoma (HCC) risk by serving as a complementary predictor of sex and two HCC prediction models, including PAGE-B score, a Caucasian cohort-derived model based on pre-treatment age, sex, and platelet count [23, 24], and REACH-B score, an Asiancohort derived model composed of age, sex, hepatitis B e antigen (HBeAg), Hepatitis B virus (HBV) DNA, and ALT [14, 25]
A major complication in non-cirrhotic chronic hepatitis B (CHB) patients after initiating prolonged nucleos(t) ide analogue (NA) is the development of HCC, but it has been a challenge to precisely predict HCC risk in these patients due to their low HCC incidence, a large cohort study with long-term follow-up is required
Our data showed that none of the 314 women with 1-year FIB-4 < 1.30 developed HCC within a mean follow-up period of 7.01 years
Summary
Prolonged nucleos(t)ide analogue (NA) treatment in CHB patients has been shown. There is a need to identify subgroups of on-treatment patients who have a minimal HCC risk (< 0.2% per year) with less need of HCC surveillance, which may help physicians to prioritize the limited medical resources in the pandemic of COVID-19 [7, 8]. Little is known about whether FIB-4 helps identify non-cirrhotic CHB patients with minimal HCC risk after prolonged nucleos(t) ide analogue (NA) therapy. Multivariable analysis showed that sex and 1-year FIB-4 were independent predictors, with none of the 314 female patients with low 1-year FIB-4 developing HCC. Conclusions In non-cirrhotic CHB patients receiving prolonged NA therapy, 1-year FIB-4 < 1.30 is useful for identifying those with minimal HCC risk by combining with female sex or low PAGE-B score
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
