Tai-Chung Tseng1,2,3, Chun-Jen Liu2,3,4, Tung-Hung Su2,3, Wan-Ting Yang3, Chi-Ling Chen4, Hung-Chih Yang2,5, Chia-Chi Wang6,7, Stephanie Fang-Tzu Kuo8, Chen-Hua Liu2,3, Pei-Jer Chen2,3,4, Ding-Shinn Chen9, Jia-Horng Kao2,3,4,10. 1. Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan. 2. Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 3. Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. 4. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. 5. Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan. 6. Division of Gastroenterology, Department of Internal Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan. 7. School of Medicine, Tzu Chi University, Hualien, Taiwan. 8. Genomics Research Center Academia Sinica, Taipei City, Taiwan. 9. St Vincent's Hospital, Melbourne, Victoria, Australia. 10. Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
OBJECTIVES: Several viral and host risk factors have been used to predict risks of hepatocellular carcinoma (HCC) in patients with chronic infection of hepatitis B virus (HBV). However, little is known whether fibrosis-4 (FIB-4) index, a liver fibrosis biomarker, helps identify non-cirrhotic patients with the lowest HCC risk. METHODS: A total of 2075 treatment-naive Taiwanese patients with chronic HBV infection were followed for an average period of 16.02 years. None of them had liver cirrhosis at baseline. We explored whether a low FIB-4 index complements the favourable predictors to defines patients with the lowest HCC risk. The finding was validated in 532 non-cirrhotic patients receiving long-term nucleos(t)ide analogue (NUC) treatment with suppressed viral replication. RESULTS: A total of 137 treatment-naive and 10 NUC-treated patients developed HCC, respectively. We found that HCC risk started to increase when baseline FIB-4 index >1.29 in the treatment-naive cohort. Patients with FIB-4 >1.29, compared to those with FIB-4 <1.29, were associated with a higher risk of HCC with hazards ratio of 5.56 (95% confidence interval: 3.93-7.86). More importantly, among patients with low viral load (HBV DNA level <2,000 IU/ml), baseline FIB-4 index helped stratify different HCC risks such that none of 326 HBeAg-negative patients with FIB-4 index <1.29, ALT level <40 U/l, and HBsAg level <1,000 IU/ml developed HCC. In addition, the patients with the FIB-4 index <1.29 consistently had the lowest HCC risks in the validation cohort receiving long-term NUC treatment. CONCLUSIONS: In non-cirrhotic patients with chronic HBV infection, FIB-4 index <1.29 complements the existing clinical profile to define patients with the lowest HCC risk.
OBJECTIVES: Several viral and host risk factors have been used to predict risks of hepatocellular carcinoma (HCC) in patients with chronic infection of hepatitis B virus (HBV). However, little is known whether fibrosis-4 (FIB-4) index, a liver fibrosis biomarker, helps identify non-cirrhotic patients with the lowest HCC risk. METHODS: A total of 2075 treatment-naive Taiwanese patients with chronic HBV infection were followed for an average period of 16.02 years. None of them had liver cirrhosis at baseline. We explored whether a low FIB-4 index complements the favourable predictors to defines patients with the lowest HCC risk. The finding was validated in 532 non-cirrhotic patients receiving long-term nucleos(t)ide analogue (NUC) treatment with suppressed viral replication. RESULTS: A total of 137 treatment-naive and 10 NUC-treated patients developed HCC, respectively. We found that HCC risk started to increase when baseline FIB-4 index >1.29 in the treatment-naive cohort. Patients with FIB-4 >1.29, compared to those with FIB-4 <1.29, were associated with a higher risk of HCC with hazards ratio of 5.56 (95% confidence interval: 3.93-7.86). More importantly, among patients with low viral load (HBV DNA level <2,000 IU/ml), baseline FIB-4 index helped stratify different HCC risks such that none of 326 HBeAg-negative patients with FIB-4 index <1.29, ALT level <40 U/l, and HBsAg level <1,000 IU/ml developed HCC. In addition, the patients with the FIB-4 index <1.29 consistently had the lowest HCC risks in the validation cohort receiving long-term NUC treatment. CONCLUSIONS: In non-cirrhotic patients with chronic HBV infection, FIB-4 index <1.29 complements the existing clinical profile to define patients with the lowest HCC risk.
Authors: Kyu Sik Jung; Seung Up Kim; Sang Hoon Ahn; Young Nyun Park; Do Young Kim; Jun Yong Park; Chae Yoon Chon; Eun Hee Choi; Kwang-Hyub Han Journal: Hepatology Date: 2011-02-11 Impact factor: 17.425
Authors: Seung Kak Shin; Hyung Joon Yim; Jeong Han Kim; Chan Uk Lee; Jong Eun Yeon; Sang Jun Suh; Young Kul Jung; Yun Soo Kim; Ju Hyun Kim; Oh Sang Kwon Journal: Gut Liver Date: 2021-05-15 Impact factor: 4.519