Nobuharu Tamaki1,2, Masayuki Kurosaki1, Yutaka Yasui1, Nami Mori3, Keiji Tsuji3, Chitomi Hasebe4, Koji Joko5, Takehiro Akahane6, Koichiro Furuta7, Haruhiko Kobashi8, Hiroyuki Kimura9, Hitoshi Yagisawa10, Hiroyuki Marusawa11, Masahiko Kondo12, Yuji Kojima13, Hideo Yoshida14, Yasushi Uchida15, Rohit Loomba2, Namiki Izumi1. 1. Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan. 2. NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA. 3. Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan. 4. Department of Gastroenterology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan. 5. Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Japan. 6. Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan. 7. Department of Gastroenterology, Masuda Red Cross Hospital, Masuda, Japan. 8. Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan. 9. Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan. 10. Department of Gastroenterology, Japanese Red Cross Akita Hospital, Akita, Japan. 11. Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan. 12. Department of Gastroenterology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 13. Department of Hepatology, Japanese Red Cross Ise Hospital, Ise, Japan. 14. Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan. 15. Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan.
Abstract
BACKGROUND: It is unclear whether the fibrosis 4 index (FIB-4), a marker of liver fibrosis, at baseline and change in FIB-4 after sustained virological response (SVR) is associated with incident hepatocellular carcinoma (HCC) risk. In this study, we examined the association of incident HCC risk with baseline FIB-4 and sustained high FIB-4 (>3.25) at any time point after SVR. METHODS: A total of 3823 patients who received direct-acting antiviral treatment and achieved SVR were enrolled. The FIB-4 was measured 24 weeks after the end of direct-acting antiviral treatment and achievement of SVR (SVR24), and 1, 2, and 3 years after SVR24, after which subsequent HCC development was investigated. RESULTS: In patients with an FIB-4 >3.25 at SVR24 and 1, 2, and 3 years after SVR24, subsequent HCC development was significantly higher than in those with an FIB-4 ≤3.25 at each point. The rates of HCC development 1, 2, 3, and 4 years after SVR24 were significantly higher in patients with sustained FIB-4 >3.25 than in those whose FIB-4 decreased to ≤3.25 (5.4%, 9.2%, 11.7%, and 16.0%, respectively, vs 2.2%, 3.1%, 3.7%, and 4.4%; P < .001). The adjusted hazard ratios (95% confidence intervals) for an FIB-4 >3.25 at SVR24 and 1, 2, and 3 years later were 3.38 (2.4-4.8), 2.95 (1.9-4.7), 2.62 (1.3-5.1), and 3.37 (1.4-9.8), respectively. CONCLUSIONS: The FIB-4 could be used to assess HCC development risk at any time after SVR, and changes in FIB-4 were associated with changes in the HCC development risk. Repeated assessments of FIB-4 could serve as a prognostic indicator of a high-risk HCC cohort that may require more intensive HCC surveillance strategy.
BACKGROUND: It is unclear whether the fibrosis 4 index (FIB-4), a marker of liver fibrosis, at baseline and change in FIB-4 after sustained virological response (SVR) is associated with incident hepatocellular carcinoma (HCC) risk. In this study, we examined the association of incident HCC risk with baseline FIB-4 and sustained high FIB-4 (>3.25) at any time point after SVR. METHODS: A total of 3823 patients who received direct-acting antiviral treatment and achieved SVR were enrolled. The FIB-4 was measured 24 weeks after the end of direct-acting antiviral treatment and achievement of SVR (SVR24), and 1, 2, and 3 years after SVR24, after which subsequent HCC development was investigated. RESULTS: In patients with an FIB-4 >3.25 at SVR24 and 1, 2, and 3 years after SVR24, subsequent HCC development was significantly higher than in those with an FIB-4 ≤3.25 at each point. The rates of HCC development 1, 2, 3, and 4 years after SVR24 were significantly higher in patients with sustained FIB-4 >3.25 than in those whose FIB-4 decreased to ≤3.25 (5.4%, 9.2%, 11.7%, and 16.0%, respectively, vs 2.2%, 3.1%, 3.7%, and 4.4%; P < .001). The adjusted hazard ratios (95% confidence intervals) for an FIB-4 >3.25 at SVR24 and 1, 2, and 3 years later were 3.38 (2.4-4.8), 2.95 (1.9-4.7), 2.62 (1.3-5.1), and 3.37 (1.4-9.8), respectively. CONCLUSIONS: The FIB-4 could be used to assess HCC development risk at any time after SVR, and changes in FIB-4 were associated with changes in the HCC development risk. Repeated assessments of FIB-4 could serve as a prognostic indicator of a high-risk HCC cohort that may require more intensive HCC surveillance strategy.
Authors: Hooman Farhang Zangneh; William W L Wong; Beate Sander; Chaim M Bell; Khalid Mumtaz; Matthew Kowgier; Adriaan J van der Meer; Sean P Cleary; Harry L A Janssen; Kelvin K W Chan; Jordan J Feld Journal: Clin Gastroenterol Hepatol Date: 2018-12-20 Impact factor: 11.382
Authors: Jorge A Marrero; Laura M Kulik; Claude B Sirlin; Andrew X Zhu; Richard S Finn; Michael M Abecassis; Lewis R Roberts; Julie K Heimbach Journal: Hepatology Date: 2018-08 Impact factor: 17.425
Authors: Nezam Afdhal; K Rajender Reddy; David R Nelson; Eric Lawitz; Stuart C Gordon; Eugene Schiff; Ronald Nahass; Reem Ghalib; Norman Gitlin; Robert Herring; Jacob Lalezari; Ziad H Younes; Paul J Pockros; Adrian M Di Bisceglie; Sanjeev Arora; G Mani Subramanian; Yanni Zhu; Hadas Dvory-Sobol; Jenny C Yang; Phillip S Pang; William T Symonds; John G McHutchison; Andrew J Muir; Mark Sulkowski; Paul Kwo Journal: N Engl J Med Date: 2014-04-11 Impact factor: 91.245