Comparison of FIB-4 Index and Child-Pugh Score in Predicting the Outcome of Hepatic Resection for Hepatocellular Carcinoma
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Background and Aims
The Child-Pugh (CP) score is a widely used method to assess liver function and predict postoperative outcomes in patients with hepatocellular carcinoma (HCC). Recently, the fibrosis index (FIB-4) has been demonstrated to be closely associated with liver fibrosis and cirrhosis. This study aimed to compare the capability of FIB-4 index with CP score in predicting the outcomes for HCC patients after hepatectomy.
A total of 495 HCC patients who underwent hepatectomy were enrolled. The performance of the FIB-4 index in predicting postoperative liver failure (PHLF) and overall survival was compared with that of the CP score.
Of them, 9.3% (46/495) patients developed PHLF. The area under the receiver operating characteristic (ROC) curve of the FIB-4 index for predicting PHLF was greater than that of the CP score (0.744 versus 0.621; P = 0.044). The optimal cutoff value of the FIB-4 index for predicting PHLF was 4.16. Multivariable analyses revealed that the FIB-4 index was an independent predictor of PHLF regardless of the hepatectomy subgroups, but the CP grade was only a significant predictor of PHLF in the minor hepatectomy subgroup. The FIB-4 index (4.16) stratified patients into two distinct overall survival cohorts (P = 0.006). The FIB-4 index also classified patients with the Barcelona Clinical Liver Cancer (BCLC) stages 0 and A into two distinct overall survival cohorts (P = 0.001 and P = 0.034, respectively).
The FIB-4 index may be a better predictor of PHLF and overall survival in HCC patients with hepatectomy than CP score.
KeywordsFIB-4 Child-Pugh score Hepatocellular carcinoma Postoperative liver failure Overall survival
This study was supported by the grants from the National Natural Science Foundation of China (No. 81773293 and No. 31660266), the Natural Science Foundation of Hunan Province (2015JJ4083 and 2018JJ3758), the Science and Technology Plan Fund in Hunan Province, P.R. China (2014WK2016, 2015GK3117, 2017DK2011, and 2017WK2063), and the Big Data Project of Xiangya Medical School, Central South University.
Pan Zhou: data analysis and manuscript draft; Bo Chen: data collection and manuscript revision; Xiong-Ying Miao: administration and material support; Li Xiong: critical revision of the manuscript for important intellectual content; Jiang-Jiao Zhou: data acquisition; Yu Wen: administrative, technical, and material support and study supervision; Heng Zou: study concept and design
Compliance with Ethical Standards
The entire study protocol was approved by the Institutional Review Board of The Second Xiangya Hospital.
Conflict of Interest
The authors declare that they have no conflict of interest.
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