Non-invasive prediction of hepatocellular carcinoma development using serum fibrosis marker in chronic hepatitis C patients

The FIB-4 index is a simple formula to predict liver fibrosis. This study aimed to evaluate the utility of the FIB-4 index and associated time-course changes as a predictor of hepatocellular carcinoma (HCC) development. A total of 171 chronic hepatitis C patients who underwent paired liver biopsies and 875 patients who underwent a single liver biopsy (validation group) were investigated during mean follow-up periods of 6.4 and 5.9 years, respectively. All patients had received interferon therapy and had not achieved a sustained virological response. Factors associated with HCC development were analyzed in these patients. HCC developed in 30 patients in the paired biopsy group and 89 patients in the validation group. Univariate analysis demonstrated that the FIB-4 index > 3.25 and change in the FIB-4 index per year (Delta FIB-4/year) a parts per thousand yen0.3 were predictive factors for HCC development in both groups. Multivariate analysis in the combined population revealed that these two factors were independent. The hazard ratio (HR) for the FIB-4 index > 3.25 was 2.7 (p < 0.001) and Delta FIB-4/year a parts per thousand yen0.3 was 1.8 (p = 0.003). Patients with a FIB-4 index > 3.25 and a Delta FIB-4/year a parts per thousand yen0.3 were defined as high risk, and those with a FIB-4 index a parts per thousand currency sign3.25 and a Delta FIB-4/year < 0.3 were defined as low risk. The HR of HCC development in patients at high risk was 7.3 (95 % confidence interval 4.3-12.5, p < 0.001). It was possible to define a group at high risk of developing HCC by intermittently measuring the FIB-4 index and considering time-course changes in this index.