Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

Nishikawa,Hiroki; Osaki,Yukio; Komekado,Hideyuki; Sakamoto,Azusa; Saito,Sumio; Nishijima,Norihiro; Nasu,Akihiro; Arimoto,Akira; Kita,Ryuichi; Kimura,Toru

doi:10.3892/or.2014.3573

Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection

Authors:
- Hiroki Nishikawa
- Yukio Osaki
- Hideyuki Komekado
- Azusa Sakamoto
- Sumio Saito
- Norihiro Nishijima
- Akihiro Nasu
- Akira Arimoto
- Ryuichi Kita
- Toru Kimura
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Affiliations: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan, Department of Surgery, Osaka Red Cross Hospital, Tennoji-ku, Osaka 543-0027, Japan
Published online on: October 30, 2014 https://doi.org/10.3892/or.2014.3573
Pages: 88-94

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Abstract

The aims of the present study were to examine the relationship between the preoperative FIB-4 index and background liver fibrosis in non-tumor parts obtained from surgical specimens and to investigate whether the FIB-4 index can be a useful predictor for non-B non-C hepatocellular carcinoma (NBNC-HCC) patients treated with surgical resection (SR). A total of 118 patients with NBNC-HCC treated with SR with curative intent were analyzed. Receiver operating characteristic (ROC) curve analysis was performed for calculating the area under the ROC (AUROC) for the FIB-4 index, aspartate aminotransferase (AST) to platelet ratio index, AST to alanine aminotransferase ratio, serum albumin, total bilirubin and platelet count for cirrhosis. We also examined predictors linked to overall survival (OS) and recurrence-free survival (RFS) after SR. The mean patient age was 68.9±9.0 years (93 males and 25 females) with a median observation period of 3.2 years. In extracted surgical specimens, background liver cirrhosis (F4) was observed in 39 patients (33.1%). The mean maximum tumor size was 5.7±3.2 cm. The mean body mass index was 24.3±3.9 kg/m2. The FIB-4 index yielded the highest AUROC for cirrhosis with a level of 0.887 at an optimal cut-off value of 2.97 (sensitivity, 92.3; specificity, 69.6%). In the multivariate analysis, serum α-fetoprotein >40 ng/ml (P=0.026) was the only significant independent predictor linked to OS, while tumor number (P=0.002) and FIB-4 index >2.97 (P=0.044) were significant factors linked to RFS. In conclusion, preoperative FIB-4 index can be a useful predictor for NBNC-HCC patients who undergo SR.

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1	Osaki Y and Nishikawa H: Treatment for hepatocellular carcinoma in Japan over the last three decades: our experience and published work review. Hepatol Res. Jun 26–2014.(Epub ahead of print). View Article : Google Scholar
2	El-Serag HB: Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 142:1264–1273. 2012. View Article : Google Scholar : PubMed/NCBI
3	de Lope CR, Tremosini S, Forner A, Reig M and Bruix J: Management of HCC. J Hepatol. 56(Suppl 1): S75–S87. 2012. View Article : Google Scholar : PubMed/NCBI
4	Kaibori M, Ishizaki M, Matsui K and Kwon AH: Clinicopathologic characteristics of patients with non-B non-C hepatitis virus hepatocellular carcinoma after hepatectomy. Am J Surg. 204:300–307. 2012. View Article : Google Scholar : PubMed/NCBI
5	Nishikawa H and Osaki Y: Non-B, non-C hepatocellular carcinoma (Review). Int J Oncol. 43:1333–1342. 2013.PubMed/NCBI
6	Utsunomiya T and Shimada M: Molecular characteristics of non-cancerous liver tissue in non-B non-C hepatocellular carcinoma. Hepatol Res. 41:711–721. 2011. View Article : Google Scholar : PubMed/NCBI
7	Umemura T and Kiyosawa K: Epidemiology of hepatocellular carcinoma in Japan. Hepatol Res. 37(Suppl 2): S95–S100. 2007. View Article : Google Scholar : PubMed/NCBI
8	Zhou WP, Lai EC, Li AJ, Fu SY, Zhou JP, Pan ZY, Lau WY and Wu MC: A prospective, randomized, controlled trial of preoperative transarterial chemoembolization for resectable large hepatocellular carcinoma. Ann Surg. 249:195–202. 2009. View Article : Google Scholar : PubMed/NCBI
9	Nishikawa H, Osaki Y, Kita R, Kimura T, Inuzuka T, Takeda H, Nakajima J, Matsuda F, Sakamoto A, Henmi S, Hatamaru K, Saito S and Nasu A: Transcatheter arterial infusion chemotherapy prior to radiofrequency thermal ablation for single hepatocellular carcinoma reduces the risk of intrahepatic distant recurrence. Int J Oncol. 41:903–909. 2012.PubMed/NCBI
10	Nishikawa H, Osaki Y, Kita R, Kimura T, Ohara Y, Takeda H, Sakamoto A, Saito S, Nishijima N, Nasu A, Komekado H and Nishiguchi S: Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma. Oncol Rep. 31:65–72. 2014.
11	Castera L: Invasive and non-invasive methods for the assessment of fibrosis and disease progression in chronic liver disease. Best Pract Res Clin Gastroenterol. 25:291–303. 2011. View Article : Google Scholar : PubMed/NCBI
12	Chrostek L and Panasiuk A: Liver fibrosis markers in alcoholic liver disease. World J Gastroenterol. 20:8018–8023. 2014. View Article : Google Scholar : PubMed/NCBI
13	Sumida Y, Nakajima A and Itoh Y: Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol. 20:475–485. 2014. View Article : Google Scholar : PubMed/NCBI
14	Smith JO and Sterling RK: Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther. 30:557–576. 2009. View Article : Google Scholar : PubMed/NCBI
15	D’Onofrio M, Crosara S, De Robertis R, Canestrini S, Demozzi E, Gallotti A and Pozzi Mucelli R: Acoustic radiation force impulse of the liver. World J Gastroenterol. 19:4841–4849. 2013. View Article : Google Scholar
16	Mariappan YK, Glaser KJ and Ehman RL: Magnetic resonance elastography: a review. Clin Anat. 23:497–511. 2010. View Article : Google Scholar : PubMed/NCBI
17	Yu ML, Lin SM, Lee CM, Dai CY, Chang WY, Chen SC, Lee LP, Lin ZY, Hsieh MY, Wang LY, Chuang WL and Liaw YF: A simple noninvasive index for predicting long-term outcome of chronic hepatitis C after interferon-based therapy. Hepatology. 44:1086–1097. 2006. View Article : Google Scholar : PubMed/NCBI
18	Castera L: Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 142:1293–1302. 2012. View Article : Google Scholar : PubMed/NCBI
19	Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, Fontaine H and Pol S: FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology. 46:32–36. 2007. View Article : Google Scholar : PubMed/NCBI
20	Angulo P, Bugianesi E, Bjornsson ESP, Mills PR, Barrera F, Haflidadottir S, Day CP and George J: Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 145:782–789.e4. 2013. View Article : Google Scholar : PubMed/NCBI
21	Tamaki N, Kurosaki M, Matsuda S, Muraoka M, Yasui Y, Suzuki S, Hosokawa T, Ueda K, Tsuchiya K, Nakanishi H, Itakura J, Takahashi Y, Asahina Y and Izumi N: Non-invasive prediction of hepatocellular carcinoma development using serum fibrosis marker in chronic hepatitis C patients. J Gastroenterol. Dec 15–2013.(Epub ahead of print). PubMed/NCBI
22	Chon YE, Jung ES, Park JY, Kim do Y, Ahn SH, Han KH, Chon CY, Jung KS and Kim SU: The accuracy of noninvasive methods in predicting the development of hepatocellular carcinoma and hepatic decompensation in patients with chronic hepatitis B. J Clin Gastroenterol. 46:518–525. 2012. View Article : Google Scholar : PubMed/NCBI
23	Shen SL, Fu SJ, Chen B, Kuang M, Li SQ, Hua YP, Liang LJ, Guo P, Hao Y and Peng BG: Preoperative aspartate aminotransferase to platelet ratio is an independent prognostic factor for hepatitis B-induced hepatocellular carcinoma after hepatic resection. Ann Surg Oncol. May 22–2014.(Epub ahead of print). View Article : Google Scholar
24	Hung HH, Su CW, Lai CR, Chau GY, Chan CC, Huang YH, Huo TI, Lee PC, Kao WY, Lee SD and Wu JC: Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma. Hepatol Int. 4:691–699. 2010. View Article : Google Scholar
25	Alberti KG and Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 15:539–553. 1998. View Article : Google Scholar : PubMed/NCBI
26	Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS and Lok AS: A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 38:518–526. 2003. View Article : Google Scholar : PubMed/NCBI
27	Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, Sulkowski MS, Torriani FJ, Dieterich DT, Thomas DL, Messinger D and Nelson M: APRICOT Clinical Investigators: Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 43:1317–1325. 2006. View Article : Google Scholar : PubMed/NCBI
28	Bruix J and Sherman M: Practice Guidelines Committee, American Association for the Study of Liver Diseases: Management of hepatocellular carcinoma. Hepatology. 42:1208–1236. 2005. View Article : Google Scholar : PubMed/NCBI
29	No authors listed. The general rules for the clinical and pathological study of primary liver cancer. Liver Cancer Study Group of Japan. Jpn J Surg. 19:98–129. 1989. View Article : Google Scholar : PubMed/NCBI
30	Utsunomiya T, Shimada M, Kudo M, Ichida T, Matsui O, Izumi N, Matsuyama Y, Sakamoto M, Nakashima O, Ku Y, Takayama T and Kokudo N; for the Liver Cancer Study Group of Japan. A Comparison of the surgical outcomes among patients with HBV-positive, HCV-positive, and non-B non-C hepatocellular carcinoma: a nationwide study of 11,950 patients. Ann Surg. Jul 28–2014.(Epub ahead of print). View Article : Google Scholar : PubMed/NCBI
31	Nalbantoglu I and Brunt EM: Role of liver biopsy in nonalcoholic fatty liver disease. World J Gastroenterol. 20:9026–9037. 2014.PubMed/NCBI
32	Wang C, Wang X, Gong G, Ben Q, Qiu W, Chen Y, Li G and Wang L: Increased risk of hepatocellular carcinoma in patients with diabetes mellitus: a systematic review and meta-analysis of cohort studies. Int J Cancer. 130:1639–1648. 2012. View Article : Google Scholar
33	Calle EE, Rodriguez C, Walker-Thurmond K and Thun MJ: Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 348:1625–1638. 2003. View Article : Google Scholar : PubMed/NCBI
34	Nishikawa H and Osaki Y: Clinical significance of therapy using branched-chain amino acid granules in patients with liver cirrhosis and hepatocellular carcinoma. Hepatol Res. 44:149–158. 2014. View Article : Google Scholar
35	Jung KS, Kim SU, Choi GH, Park JY, Park YN, Kim do Y, Ahn SH, Chon CY, Kim KS, Choi EH, Choi JS and Han KH: Prediction of recurrence after curative resection of hepatocellular carcinoma using liver stiffness measurement (FibroScan^®). Ann Surg Oncol. 19:4278–4286. 2012. View Article : Google Scholar : PubMed/NCBI
36	Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S and Makuuchi M: Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 38:200–207. 2003. View Article : Google Scholar : PubMed/NCBI
37	McCurry J: Japan battles with obesity. Lancet. 369:451–452. 2007. View Article : Google Scholar : PubMed/NCBI
38	Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity. New criteria for ‘Obesity Disease’ in Japan. Circ J. 66:987–992. 2002. View Article : Google Scholar