A novel, non-invasive model for diagnosing liver fibrosis stage in patients with hepatocellular carcinoma

Abstract

The aim of this study was to investigate the diagnostic value of the platelet count-to-spleen volume ratio (PSR) for diagnosing hepatic fibrosis in patients with hepatocellular carcinoma (HCC). In this interim analysis of an on-going prospective study, 117 patients with HCC and with or without cirrhosis or fibrosis in different stages were analyzed. Fibrosis staging negatively correlated with PSR and the liver volume-to-spleen volume ratio (LSR), while it positively correlated with aspartate aminotransferase-to-platelet ratio index (APRI), Frons' index, S-index and a fibrosis index based on four factors (FIB-4). The area under the receiver operating characteristic curve (AUROC) was significantly larger for PSR (0.777) than LSR (0.633, P = 0.002). Among patients with significant fibrosis, AUROC for PSR did not differ significantly from the AUROCs for APRI (0.789, P = 0.825), Frons' index (0.674, P = 0.102), FIB-4 (0.704, P = 0.251) or S-index (0.696, P = 0.204). Among patients with severe fibrosis, AUROC was significantly higher for PSR (0.808) than for LSR (0.685, P = 0.003), Frons' index (0.673, P = 0.014), FIB-4 (0.684, P = 0.029), or S-index (0.672, P = 0.016); in contrast, the AUROC for PSR was not significantly different from that for APRI (0.739, P = 0.215). Among patients with cirrhosis, AUROC was significantly higher for PSR (0.814) than for LSR (0.671, P = 0.001) or S-index (0.679, P = 0.022), while the AUROC for PSR did not differ significantly from those for APRI (0.711, P = 0.105), Frons' index (0.722, P = 0.061) or FIB-4 (0.708, P = 0.079). Our results suggest that PSR may be a useful non-invasive model for diagnosing liver fibrosis stage in patients with HCC in China.

Figure 1

(a,b) Contours of liver and spleen filled with different colors. (c,d) Volume representing images of liver and spleen after reconstruction.

Figure 2

Postoperative pathological hepatic fibrosis staging. (a) Fibrosis stage F0 (HE × 40); (b) Fibrosis stage F1 (HE × 40); (c) Fibrosis stage F3 (HE × 40); (d) Fibrosis stage F4 (HE × 40); (e) Fibrosis stage F5 (HE × 40)).

Figure 3

Box plots of the comparison of liver fibrosis models scores of different liver stages. (a) PSR, P < 0.001; (b) LSR, P = 0.006; (c) APRI, P = 0.002; (d) Frons’ index, P = 0.001; (e) FIB-4 index, P = 0.001; and (f) S-index, P = 0.002).

Figure 4

Receiver operating characteristic curves of hepatic fibrosis models for evaluating significant fibrosis (a) severe fibrosis (b) and cirrhosis (c).