Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Jan;61(2):278-285.
doi: 10.1111/apt.18346. Epub 2024 Oct 27.

Prevalence of Low FIB-4 in MASLD-Related Hepatocellular Carcinoma: A Multicentre Study

Darren Jun Hao Tan  1 , Nobuharu Tamaki  2 , Beom Kyung Kim  3 , Karn Wijarnpreecha  4 , Majd Bassam Aboona  4 , Claire Faulkner  4 , Charlotte Kench  5 , Shirin Salimi  5 , Abdul-Hamid Sabih  5 , Wen Hui Lim  1 , Pojsakorn Danpanichkul  6 , Benjamin Tay  7 , Yiqing Teh  7 , John Mok  7 , Benjamin Nah  7 , Cheng Han Ng  7 , Mark Muthiah  1   7 , Anand V Kulkarni  8 , Sung Won Lee  9 , Ken Liu  7 , Rohit Loomba  10   11 , Daniel Q Huang  1   7 ; Global Liver Cancer Consortium
Affiliations
Multicenter Study

Prevalence of Low FIB-4 in MASLD-Related Hepatocellular Carcinoma: A Multicentre Study

Darren Jun Hao Tan et al. Aliment Pharmacol Ther. 2025 Jan.

Abstract

Background: Major society guidelines recommend the fibrosis-4 index (FIB-4) as the initial step to risk stratifying people with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to evaluate the proportion of people with MASLD-related hepatocellular carcinoma (HCC) and a low FIB-4.

Methods: This cohort study included 613 consecutive adults (33% female) diagnosed with MASLD-related HCC from January 2008 to August 2023 at seven international centres in Australia, India, Japan, South Korea, Singapore and the United States. The primary objective was to determine the proportion of participants with a low FIB-4, defined as FIB-4 < 1.3, or < 2 if age > 65 years, in people without cirrhosis.

Results: The mean (±SD) age and body mass index were 71 (±11) years and 27 (±7) kg/m2, respectively. Overall, 235 participants (38%) did not have known cirrhosis. The median FIB-4 was 3.90 (IQR 2.42-6.42). A total of 78 participants (13%) had a low FIB-4. Among participants without known cirrhosis (n = 235), 62 participants (26%) had a low FIB-4. Participants with a low FIB-4 had larger median total tumour diameter (p < 0.001) and lower median serum alpha-fetoprotein (p = 0.005), compared to participants without a low FIB-4. Cirrhosis was associated with lower odds of low FIB-4, but not other factors such as male sex, type 2 diabetes, or obesity.

Conclusion: More than a quarter of those with MASLD-related HCC without cirrhosis have a low FIB-4. The proposed clinical care pathways may not identify these people for further evaluation.

Keywords: MASH; hepatoma; liver cancer; surveillance.

PubMed Disclaimer

References

    1. Z. M. Younossi, A. B. Koenig, D. Abdelatif, Y. Fazel, L. Henry, and M. Wymer, “Global Epidemiology of Nonalcoholic Fatty Liver Disease‐Meta‐Analytic Assessment of Prevalence, Incidence, and Outcomes,” Hepatology 64, no. 1 (2016): 73–84.
    1. C. Estes, Q. M. Anstee, M. T. Arias‐Loste, et al., “Modeling NAFLD Disease Burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and the United States for the Period 2016–2030,” Journal of Hepatology 69, no. 4 (2018): 896–904.
    1. K. Riazi, H. Azhari, J. H. Charette, et al., “The Prevalence and Incidence of NAFLD Worldwide: A Systematic Review and Meta‐Analysis,” Lancet Gastroenterology & Hepatology 7, no. 9 (2022): 851–861.
    1. D. Q. Huang, H. B. El‐Serag, and R. Loomba, “Global Epidemiology of NAFLD‐Related HCC: Trends, Predictions, Risk Factors and Prevention,” Nature Reviews Gastroenterology & Hepatology 18, no. 4 (2021): 223–238.
    1. R. Loomba and A. J. Sanyal, “The Global NAFLD Epidemic,” Nature Reviews. Gastroenterology & Hepatology 10, no. 11 (2013): 686–690.

Publication types

LinkOut - more resources