Usefulness of FIB-4 index and ALT at 1 year of nucleos(t)ide analog treatment for prediction of hepatocellular carcinoma in chronic hepatitis B patients.

AIM: Nucleos(t)ide analogs (NAs) do not completely prevent hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) infection. This study aimed to evaluate the dynamics of a non-invasive liver fibrosis marker, FIB-4 index, for predicting HCC development.

METHODS: Among a total of 882 chronically HBV-infected patients who were treated with NAs, 472 patients without HCC history whose FIB-4 at baseline and 1 year of treatment was obtained were evaluated for the incidence of HCC.

RESULTS: The median FIB-4 was 2.00 at baseline and was significantly reduced to 1.58 at 1 year (P<0.001), but the reduction was small at 2 years or later. When a receiver operating characteristic analysis of FIB-4 was performed to predict HCC within 5 years, the area under the curve of FIB-4 at 1 year was higher than that at baseline (0.676 vs. 0.599). The HCC incidence was significantly higher in patients with FIB-4≥1.58 than in those with FIB-4<1.58 (14.8% vs. 3.6% at 10 years, P<0.001). Additionally, an abnormal ALT (≥31 U/L) at 1 year was an independent risk for HCC. When a FAL-1 score was evaluated as an applicable number of FIB-4≥1.58 and ALT≥31 as 0, 1 and 2, the HCC risk in patients with score 2 was significantly higher than in those with score 1 or score 0 (24.1% vs. 9.8% vs. 0.7% at 10 years, P<0.001).

CONCLUSIONS: FIB-4≥1.58 and ALT≥31 at 1 year of NA were an independent risk factor for HCC development, and a score using these factors stratified the risk of HCC. This article is protected by copyright. All rights reserved.