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. 2010 Sep 24;4(4):691-9.
doi: 10.1007/s12072-010-9213-3.

Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma

Hung-Hsu Hung, Chien-Wei Su, Chiung-Ru Lai, Gar-Yang Chau, Che-Chang Chan, Yi-Hsiang Huang, Teh-Ia Huo, Pui-Ching Lee, Wei-Yu Kao, Shou-Dong Lee, Jaw-Ching Wu

Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma

Hung-Hsu Hung et al. Hepatol Int. .

Abstract

Purpose: Although advanced liver fibrosis is crucial in the development of hepatocellular carcinoma (HCC) for patients with chronic hepatitis B, whether it is associated with the recurrence of HCC after resection remains obscure. This study was aimed to compare the outcomes for patients with minimal or advanced fibrosis in solitary small hepatitis B virus (HBV)-related HCC.

Methods: This study enrolled 76 patients with small (<5 cm) solitary HBV-related HCC who underwent resection. The outcomes of patients with minimal and advanced fibrosis in non-tumor areas were compared. Serum markers were tested to assess the stage of hepatic fibrosis and to predict prognosis.

Results: Fourteen patients with an Ishak fibrosis score of 0 or 1 were defined as having minimal fibrosis; the remaining 62 patients were defined as having advanced fibrosis. During a follow-up period of 77.0 ± 50.7 months, 41 patients died. The overall survival rate was significantly higher (P = 0.018) and recurrence rate was lower (P = 0.018) for patients in the minimal fibrosis group. Aspartate aminotransferase-platelet ratio index (APRI) exhibited the most reliable discriminative ability for predicting advanced fibrosis. The overall survival rate was significantly higher (P = 0.003) and recurrence rate was lower (P = 0.005) for patients with an APRI of 0.47 or less.

Conclusions: For patients with solitary small HBV-related HCC who underwent resection, minimal fibrosis is associated with a lower incidence of recurrence and with better survival. APRI could serve as a reliable marker for assessing hepatic fibrosis and predicting survival.

Keywords: Aspartate aminotransferase–platelet ratio index; Fibrosis; Hepatitis B virus; Hepatocellular carcinoma; Recurrence.

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Figures

Fig. 1
Fig. 1
aBox and whisker graph shows the relationship between the stage of fibrosis and the APRI. The middle horizontal line inside each box depicts the median, and the width of each box represents the 25th and 75th percentiles. Vertical lines represent the 10th and 90th percentiles. b Receiver operating curves (ROCs) of APRI, ICG-15R, albumin, bilirubin, platelet count and prothrombin time INR for the prediction of advanced fibrosis in patients with small and solitary HCC
Fig. 2
Fig. 2
Cumulative overall survival and recurrences stratified by the stage of fibrosis and serum APRI level at the time of surgery. The cumulative curves were plotted using the Kaplan–Meier method and compared by a log-rank test. Patients with advanced fibrosis had poorer overall survival (a, P = 0.018), as well as a significantly higher incidence of recurrence (c, P = 0.018) than those with minimal fibrosis in non-tumor parts. Patients with serum APRI levels of more than 0.47 at the time of surgery had poorer overall survival (b, P = 0.003), and a higher incidence of recurrence (d, P = 0.005) than their counterparts with serum APRI levels of <0.47
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