Skip to main content

Advertisement

SpringerLink
Log in

The FIB-4 index is a significant prognostic factor in patients with non-B non-C hepatocellular carcinoma after curative surgery

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) index were developed as a non-invasive parameter for predicting liver fibrosis. This study aimed to validate the APRI and FIB-4 indexes in patients treated with curative therapy for non-B non-C (NBNC) hepatocellular carcinoma (HCC).

Methods

Accumulated database comprising 399 patients who underwent hepatectomy was reviewed retrospectively. Analyses were performed to evaluate whether the APRI and FIB-4 indexes are predictors of liver cirrhosis and/or the prognosis in patients with NBNC-HCC. Forty-seven patients with NBNC-HCC who underwent curative radiofrequency ablation therapy (RFA) in the same period were enrolled as the validation set.

Results

The APRI and FIB-4 indexes were significantly higher in the cirrhosis group than in the no-cirrhosis group (P = 0.001 and P < 0.001, respectively). A receiver operating characteristic curve analysis showed that the FIB-4 index was more accurate in predicting background liver cirrhosis than the APRI. According to a multivariate analysis, an FIB-4 index larger than 2.7 (hazard ratio 2.11 and 2.21, 95 % confidence interval 1.06–4.18 and 1.38–3.54, P = 0.033 and P = 0.001) remained significant independent predictors of overall and recurrence-free survival, respectively.

Conclusions

The present findings showed that the FIB-4 index is a significant predictor of background liver cirrhosis and the prognosis after curative resection for NBNB-HCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  2. Tanaka H, Imai Y, Hiramatsu N et al (2008) Declining incidence of hepatocellular carcinoma in Osaka, Japan, from 1990 to 2003. Ann Intern Med 148:820–826

    Article  PubMed  Google Scholar 

  3. Utsunomiya T, Shimada M (2011) Molecular characteristics of non-cancerous liver tissue in non-B non-C hepatocellular carcinoma. Hepatol Res 41:711–721

    Article  PubMed  Google Scholar 

  4. Nagaoki Y, Hyogo H, Aikata H et al (2012) Recent trend of clinical features in patients with hepatocellular carcinoma. Hepatol Res 42:368–375

    Article  CAS  PubMed  Google Scholar 

  5. Hatanaka K, Kudo M, Fukunaga T et al (2007) Clinical characteristics of nonB nonC-HCC: comparison with HBV and HCV related HCC. Intervirology 50:24–31

    Article  PubMed  Google Scholar 

  6. Kaibori M, Ishizaki M, Matsui K et al (2012) Clinicopathologic characteristics of patients with non-B non-C hepatitis virus hepatocellular carcinoma after hepatectomy. Am J Surg 204:300–307

    Article  PubMed  Google Scholar 

  7. Nishikawa H, Arimoto A, Wakasa T et al (2013) Comparison of clinical characteristics and survival after surgery in patients with non-B and non-C hepatocellular carcinoma and hepatitis virus-related hepatocellular carcinoma. J Cancer 4:502–513

    Article  PubMed  PubMed Central  Google Scholar 

  8. Utsunomiya T, Shimada M, Kudo M et al (2015) 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 261:513–520

    Article  PubMed  Google Scholar 

  9. Wai CT, Greenson JK, Fontana RJ et al (2003) A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 38:518–526

    Article  PubMed  Google Scholar 

  10. Sterling RK, Lissen E, Clumeck N et al (2006) Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 43:1317–1325

    Article  CAS  PubMed  Google Scholar 

  11. Shah AG, Lydecker A, Murray K et al (2009) Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 7:1104–1112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Adams LA, George J, Bugianesi E et al (2011) Complex non-invasive fibrosis models are more accurate than simple models in non-alcoholic fatty liver disease. J Gastroenterol Hepatol 26:1536–1543

    Article  CAS  PubMed  Google Scholar 

  13. Sumida Y, Yoneda M, Hyogo H et al (2012) Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol 5(12):2. doi:10.1186/1471-230X-12-2

    Article  Google Scholar 

  14. Angulo P, Bugianesi E, Bjornsson ES et al (2013) Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 145:782–789

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kawamura Y, Arase Y, Ikeda K et al (2012) Large-scale long-term follow-up study of Japanese patients with non-alcoholic fatty liver disease for the onset of hepatocellular carcinoma. Am J Gastroenterol 107:253–261

    Article  CAS  PubMed  Google Scholar 

  16. Tamaki N, Kurosaki M, Matsuda S et al (2014) Non-invasive prediction of hepatocellular carcinoma development using serum fibrosis marker in chronic hepatitis C patients. J Gastroenterol 49:1495–1503

    Article  CAS  PubMed  Google Scholar 

  17. Hung HH, Su CW, Lai CR et al (2010) Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma. Hepatol Int 24:691–699

    Article  Google Scholar 

  18. Shen SL, Fu SJ, Chen B et al (2014) Preoperative aspartate aminotransferase to platelet ratio is an independent prognostic factor for hepatitis B-induced hepatocellular carcinoma after hepatic resection. Ann Surg Oncol 21:3802–3809

    Article  PubMed  Google Scholar 

  19. Nishikawa H, Osaki Y, Komekado H et al (2015) Clinical significance of the FIB-4 index for non-B non-C hepatocellular carcinoma treated with surgical resection. Oncol Rep 33:88–94

    CAS  PubMed  Google Scholar 

  20. Toyoda H, Kumada T, Tada T et al (2015) A laboratory marker, FIB-4 index, as a predictor for long-term outcomes of hepatocellular carcinoma patients after curative hepatic resection. Surgery 157:699–707

    Article  PubMed  Google Scholar 

  21. Sobin LH, Gospodarowicz MK, Wittekind CH (eds) (2009) TNM classification of malignant tumours, 7th edn. Wiley-Liss, New York

    Google Scholar 

  22. Hassan MM, Hwang LY, Hatten CJ et al (2002) Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology 36:1206–1213

    Article  CAS  PubMed  Google Scholar 

  23. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications of surgery with evaluation in a cohort of 6366 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  24. Okamura Y, Ito T, Sugiura T et al (2014) Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg 18:1994–2002

    Article  PubMed  Google Scholar 

  25. Pugh RNH, Murray-Lyon IM, Dawson JL et al (1973) Transection of the esophagus for bleeding oesophageal varices. Br J Surg 60:646–649

    Article  CAS  PubMed  Google Scholar 

  26. Liver Cancer Study Group of Japan (2003) The general rules for the clinical and pathological study of primary liver cancer, 2nd edn. Kanehara, Tokyo

    Google Scholar 

  27. Bedossa P, Poynard T (1996) An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 24:289–293

    Article  CAS  PubMed  Google Scholar 

  28. Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1557

    Article  PubMed  Google Scholar 

  29. Utsunomiya T, Shimada M, Kudo M et al (2014) Nationwide study of 4741 patients with non-B non-C hepatocellular carcinoma with special reference to the therapeutic impact. Ann Surg 259:336–345

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Yukiyasu Okamura, Ryo Ashida, Yusuke Yamamoto, Takaaki Ito, Teiichi Sugiura & Katsuhiko Uesaka

  2. Interventional Radiology, Shizuoka Cancer Center Hospital, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Emima Bekku & Takeshi Aramaki

Authors
  1. Yukiyasu Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryo Ashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teiichi Sugiura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emima Bekku
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takeshi Aramaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katsuhiko Uesaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yukiyasu Okamura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

No funding support for this study was received.

Ethical approval

The study was approved by the ethics committee of the Shizuoka Cancer Center Hospital. All patients provided informed consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okamura, Y., Ashida, R., Yamamoto, Y. et al. The FIB-4 index is a significant prognostic factor in patients with non-B non-C hepatocellular carcinoma after curative surgery. Langenbecks Arch Surg 401, 195–203 (2016). https://doi.org/10.1007/s00423-016-1389-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1389-0

Keywords

Search

Navigation