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. 2023 Aug 2;2(8):1093-1102.
doi: 10.1016/j.gastha.2023.07.018. eCollection 2023.

Validation of Noninvasive Markers for HCC Risk Stratification in 1389 Patients With Biopsy-proven NAFLD

Hidenori Toyoda  1 , Hideki Fujii  2   3 , Michihiro Iwaki  4 , Hideki Hayashi  5 , Satoshi Oeda  6   7 , Hideyuki Hyogo  8 , Miwa Kawanaka  9 , Asahiro Morishita  10 , Kensuke Munekage  11 , Kazuhito Kawata  12 , Sakura Yamamura  13 , Koji Sawada  14 , Tatsuji Maeshiro  15 , Hiroshi Tobita  16 , Yuichi Yoshida  17 , Masafumi Naito  17 , Asuka Araki  16 , Shingo Arakaki  15 , Takumi Kawaguchi  13 , Hidenao Noritake  12 , Masafumi Ono  18 , Tsutomu Masaki  10 , Satoshi Yasuda  1 , Eiichi Tomita  5 , Masato Yoneda  4 , Norifumi Kawada  2 , Akihiro Tokushige  19 , Yoshihiro Kamada  20 , Hirokazu Takahashi  6 , Shinichiro Ueda  19 , Shinichi Aishima  21 , Yoshio Sumida  22 , Atsushi Nakajima  3 , Takeshi Okanoue  23 ; Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)
Affiliations

Validation of Noninvasive Markers for HCC Risk Stratification in 1389 Patients With Biopsy-proven NAFLD

Hidenori Toyoda et al. Gastro Hep Adv. .

Abstract

Background and aims: Nonalcoholic fatty liver diseases (NAFLD) and nonalcoholic steatohepatitis (NASH) can cause hepatocellular carcinoma (HCC). We examined histological features and reported noninvasive markers/models for stratifying the risk of HCC development in patients with biopsy-proven NAFLD or NASH.

Methods: A total of 1389 patients who had a histological diagnosis of NAFLD or NASH based on liver biopsy and underwent regular surveillance for HCC were included. The ability to predict HCC development was compared between histological features including liver fibrosis and NAFLD activity score, and noninvasive markers/models including aMAP (age, male, albumin-bilirubin, and platelet) score, FIB-4 (Fibrosis-4) index, and ALBI (albumin-bilirubin) score calculated at the time of biopsy.

Results: The C index of aMAP score was 0.887, which was consistent with the original report, comparable to FIB-4 index (0.878), and higher than those of ALBI score (0.789), histological liver fibrosis (0.723), and NAFLD activity score (0.589). The hazard ratios for HCC development in the aMAP intermediate and high-risk groups were 21.0 (95% confidence interval [CI], 3.6-402.0) and 110.3 (95% CI, 16.3-2251.4), respectively, in comparison to the aMAP score low-risk group. Those in the FIB-4 index moderate- and high-fibrosis groups were 10.3 (95% CI, 1.7-199.8) and 93.1 (95% CI, 16.3-1773.8), respectively, in comparison to the FIB-4 index mild-fibrosis group. No patients in the aMAP score low-risk group developed HCC during the study period.

Conclusion: For stratifying the risk of HCC development in patients with biopsy-proven NAFLD or NASH, both aMAP score and FIB-4 index showed high discriminative ability as noninvasive markers, which were superior histological features.

Keywords: ALBI Score; FIB-4 Index; Hepatocellular Carcinoma; Nonalcoholic Fatty Liver Disease; aMAP Score.

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Figures

Figure 1
Figure 1
Incidence of hepatocellular carcinoma stratified by baseline laboratory markers or histological characteristics in the overall study population with biopsy-proven nonalcoholic fatty liver disease. (A) aMAP score, (B) Fib-4 index, (C) ALBI score, (D) histological liver fibrosis, and (E) histological NAS score.
Figure 2
Figure 2
Incidence of hepatocellular carcinoma stratified by baseline laboratory markers in patients with F0, F1, or F2 liver fibrosis based on liver biopsy results. (A) aMAP score, (B) Fib-4 index, and (C) ALBI score.
Figure 3
Figure 3
Incidence of hepatocellular carcinoma stratified by baseline laboratory markers in patients with F3 or F4 liver fibrosis based on liver biopsy results. (A) aMAP score, (B) Fib-4 index, and (C) ALBI score.
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