FIB-4 score after 1 year of antiviral therapy can predict the risk of liver cancer in patients with non-cirrhosis | Research Express

Author: Cai Hao East chief physician Beijing Ditan Hospital, the medical article is the author's permission Naomaitong release, please do not reprint without authorization.

Introduction Hepatitis B virus (HBV) infection is an important factor leading to hepatocellular carcinoma.
Nucleoside (acid) drug treatment can significantly reduce the risk of hepatocellular carcinoma, but there are still a few patients who develop hepatocyte kk.

According to previous studies, the annual incidence of hepatocellular carcinoma in HBV-infected patients with liver cirrhosis is 3% to 6%, and the annual incidence of non-cirrhotic hepatocellular carcinoma is 0.
5% to 1.
0%.

Therefore, the monitoring of hepatocellular carcinoma in patients with liver cirrhosis has received extensive attention.

Non-cirrhotic patients are easily overlooked because of the low risk of hepatocellular carcinoma.

It is necessary to find out the high-risk population of hepatocellular carcinoma from non-cirrhotic patients and focus on monitoring.

Recently, a study by Tseng et al.
[1] attracted my attention.

Study introduction Tseng et al.
retrospectively analyzed 1936 patients treated with entecavir and tenofovir fumarate in multiple studies to explore whether the fibrosis 4 score (FIB-4) can predict these The patient's risk of hepatocellular carcinoma.

1936 patients were followed up for an average of 6.
98 years, and 48 patients developed liver cancer.

The results of the study found that the level of FIB-4 in these patients 1 year after treatment was related to the occurrence of hepatocellular carcinoma, and was better than the level of FIB-4 before treatment (Figure 1).

Figure 1 Baseline, 1-year and 2-year ROC curve of FIB-4 and hepatocellular carcinoma risk of antiviral therapy.
The cut-off value of FIB-4 is set at 1.
30, and patients are classified as low FIB-4 according to 1-year FIB-4 Group (<1.
30) and high FIB-4 group (>1.
30). Compared with the low FIB-4 group, the high FIB-4 group had an increased risk of liver cancer (HR=4.
87, 95%CI: 2.
48-9.
55).

See Figure 2.

Figure 2 Multivariate analysis of the cumulative incidence of hepatocellular carcinoma in patients with FIB-4<1.
30 and >1.
30 at 1 year showed that gender and 1-year FIB-4 were independent predictors, and there was no case in the 314 female low FIB-4 group.
Hepatocellular carcinoma occurs; PAGE-B score (a score composed of baseline age, gender, and platelet count) can also be combined.
The annual incidence of hepatocellular carcinoma in patients with low FIB-4 group and PAGE-B <10 is 0.
11%.

Research conclusions The research results of Tseng et al.
showed that in chronic hepatitis B patients with non-cirrhosis who have been treated with nucleoside (acid) drugs for a long period of time, 1 year FIB-4<1.
30 combined with women or low PAGE-B scores can help identify Patients with the least risk of hepatocellular carcinoma.

References: [1]Tseng TC, Choi J, Nguyen MH, et al.
One-year Fibrosis-4 index helps identify minimal HCC risk in non-cirrhotic chronic hepatitis B patients with antiviral treatment[J].
Hepatol Int.
2021: 1-9.