In a cohort of patients with chronic hepatitis B without cirrhosis, the risk for hepatocellular carcinoma was significantly higher among those with a FIB-4 index over 1.29, according to recently published data.
“Implementation of HCC surveillance is important because it is the only way to identify HCC at an early stage, which reduces disease-related morbidity and mortality,” Tai-Chung Tseng, MD, PhD, from the National Taiwan University Hospital Jinshan Branch, and colleagues wrote. “On the basis of our data, the patients with baseline FIB-4 index [lower than] 1.29 and a favorable clinical profile did not develop HCC within 16 years of follow-up. This finding helps practicing physicians identify the patients with the lowest HCC risks, who may not have additional benefit from HCC surveillance.”
To confirm the role of FIB-4 index in association with HCC risk, the researchers enrolled 2,075 treatment-naive adults with chronic HBV without cirrhosis. Additionally, the study comprised a validation cohort of 532 patients who received long-term nucleos(t)ide analogue (NUC) treatment from 2004 to 2012.
Mean FIB-4 was 1.11 (range, 0.23-6.65). During follow-up, 137 patients developed HCC with an incidence rate of 0.41 cases per 100 person-years.
All patients with an FIB-4 index over 1.29 had an increased risk for HCC (HR = 5.56; 95% CI, 3.93-7.86) vs. those with an index below 1.29. The cut-off of an index higher than 1.29 remained significant after adjusting for age, sex, alanine aminotransferase and aspartate aminotransferase, HBeAg, genotype, HBV DNA and HBsAg levels (HR = 2.27; 95% CI, 1.26-3.8).
Patients in the validation cohort received long-term NUC treatment for a mean of 6.69 years (range, 1.28-11.88 years). Ten of these patients developed HCC with an incidence rate of 0.27 cases per 100 person-years. The researchers observed that FIB-4 index higher than 1.29 at both baseline (P = .023) and 1-year (P < .001) was significantly correlated with higher risk for HCC among patients treated with NUC treatment.
“Our treatment-naive data suggests that the risks of HBV-related HCC are extremely low if the patients do not have significant fibrosis. This hypothesis was further supported by our on-treatment data that no HCC developed in NUC-treated patients FIB-4 [below] 1.29 ... which suggest an early anti-viral therapy may minimize the HCC risk,” the researchers concluded. – by Talitha Bennett
Disclosure: Tseng reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures