Utility of FIB4-T as a Prognostic Factor for Hepatocellular Carcinoma.

Kazuya Kariyama,Toru Ishikawa,Takashi Kumada,Akiko Wakuta, For Hcc (Relpec) Study Group,Kazuhiro Nouso,Hcc Fourtyeight Group,Ayano Oonishi,Toshifumi Tada,Masatoshi Kudo,Ei Itobayashi,Hidenori Toyoda,Kunihiko Tsuji,Atsushi Hiraoka

doi:10.3390/cancers11020203

Abstract

Background: Most integrated scores for predicting the prognosis of patients with hepatocellular carcinoma (HCC) comprise tumor progression factors and liver function variables. The FIB4 index is an indicator of hepatic fibrosis calculated on the basis of age, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, and platelet count, but it does not include variables directly related to liver function. We propose a new staging system, referred to as “FIB4-T,” comprising the FIB4 index as well as tumor progression factors, and examine its usefulness. Method: Subjects included 3800 cases of HCC registered in multiple research centers. We defined grades 1, 2, and 3 as a Fibrosis-4 (FIB4) index of <3.25, 3.26–6.70, and >6.70 as FIB4, respectively, and calculated the FIB4-T in the same manner in which the JIS (Japan Integrated Staging Score) scores and albumin-bilirubin tumor node metastasis (ALBI-T) were calculated. We compared the prognostic prediction ability of FIB4-T with that of the JIS score and ALBI-T. Results: Mean observation period was 37 months. The 5-year survival rates (%) of JIS score (0/1/2/3/4/5), ALBI-T (0/1/2/3/4/5) and FIB4-T (0/1/2/3/4/5) were 74/60/36/16/0, 82/66/45/22/5/0 and 88/75/65/58/32/10, respectively. Comparisons of the Akaike information criteria among JIS scores, ALBI-T, and FIB4-T indicated that stratification using the FIB4-T system was comparable to those using ALBI-T and JIS score. The risk of mortality significantly increased (1.3–2.8 times/step) with an increase in FIB4-T, and clear stratification was possible regardless of the treatment. Conclusions: FIB4-T is useful in predicting the prognosis of patients with HCC from a new perspective.

Highlights

Liver cancer is the second leading cause of death due to cancer worldwide and was responsible for 788,000 deaths in 2015 [1]
Liver fibrosis progresses from various factors, such as genetic factors, viral or non-viral inflammation, influence by drugs, is considered to be involved in carcinogenesis, is known to be a risk factor for hepatocellular carcinoma (HCC) development following sustained virological response to hepatitis C virus (HCV), and can determine the prognosis of patients with cirrhosis [7]
Subjects used in this analysis included 3800 HCC cases registered in multiple collaborative hospitals

Summary

Introduction

Liver cancer is the second leading cause of death due to cancer worldwide and was responsible for 788,000 deaths in 2015 [1]. The prognosis of hepatocellular carcinoma (HCC) is regulated by tumor factors and liver function of the background liver. The FIB4 index was developed in 2006 by Sterling as a non-invasive method to diagnose liver fibrosis and combines aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, platelet count, and age [8]. Most integrated scores for predicting the prognosis of patients with hepatocellular carcinoma (HCC) comprise tumor progression factors and liver function variables. The. FIB4 index is an indicator of hepatic fibrosis calculated on the basis of age, aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, and platelet count, but it does not include variables directly related to liver function. We propose a new staging system, referred to as “FIB4-T,” comprising the FIB4 index as well as tumor progression factors, and examine its usefulness

Methods

Results

Conclusion