Fibrosis-4 Model Influences Results of Patients with Hepatocellular Carcinoma Undergoing Hepatectomy

Abstract

Background: Several noninvasive models based on routine laboratory index have been developed to predict liver fibrosis. Our aim is to discuss whether these indexes could predict prognosis in patients with hepatocellular carcinoma undergoing hepatectomy.

Methods: This study retrospectively enrolled 788 consecutive hepatocellular carcinoma patients undergoing liver resection in the cohort. Univariate and multivariate analysis were used to identify the risk factors of complications, survival, and disease-free survival.

Results: Fibrosis-4 index had the best prediction ability for cirrhosis among other noninvasive models. Both the univariate and multivariate analyses showed that fibrosis-4 was independent risk factor for survival and disease-free survival. With the optimal cutoff value of 3.15, patients with fibrosis-4 ⩾3.15 had higher postoperative hepatic insufficiency (P=0.006) and worse survival than the fibrosis-4<3.15 group. The corresponding 1-year, 3-year, and 5-year overall survival were 80.9%, 56.3%, and 44.6% in the High fibrosis-4 group and were 86.5%, 69.9%, and 63.2% in the Low fibrosis-4 group, respectively (P<0.001). Worse disease-free survival was also observed in the fibrosis-4 ⩾3.15 group; the corresponding 1-year, 3-year, and 5-year disease-free survival were 74.9%, 45.3%, and 24.6% for the fibrosis-4 ⩾3.15 group and were 81.8%, 54.9%, and 34.4% for the fibrosis-4<3.15 group (P=0.009).

Conclusions: Fibrosis-4 is useful for assessing the short-term and long-term results for hepatocellular carcinoma patients with liver resection.

Figure 1

Receiver operating characteristic curve for King score, APRI, Lok index, AST/ALT, Child-Pugh score, and fibrosis-4 in relation to cirrhosis.

Figure 2

The 1-year, 3-year, and 5-year overall survival between fibrosis-4 ≥3.15 group and fibrosis-4<3.15 group. Fibrosis-4 ≥3.15 group had worse survival than the fibrosis-4<3.15 group, with the corresponding 1-year, 3-year, and 5-year overall survival of 80.9%, 56.3%, and 44.6% for fibrosis-4 ≥3.15 group and 86.5%, 69.9%, and 63.2% for fibrosis-4<3.15 group (P<0.001).

Figure 3

The 1-year, 3-year, and 5-year disease-free survival between fibrosis-4 ≥3.15 group and fibrosis-4<3.15 group. Worse disease-free survival was also observed in the fibrosis-4 ⩾3.15 group; the corresponding 1-year, 3-year, and 5-year disease-free survival were 74.9%, 45.3%, and 24.6% for fibrosis-4 ⩾3.15 group and 81.8%, 54.9%, and 34.4% for the fibrosis-4<3.15 group (P=0.009).