Baseline FIB-4 May Be a Risk Factor of Recurrence After SBRT in Patients With HBV-Related Small HCC

Overview

Journal Cancer Med

Date 2025 Jan 9

PMID 39783856

Authors

Zhan Zeng

Yifan Han

Wengang Li

Hongyu Chen

Ning Lin

Yanyan Yu

Xiaoyuan Xu

Affiliations

Soon will be listed here.

Abstract

Aims: Exploring fibrosis index-4 (FIB-4)'s predictive value for HBV-related hepatocellular carcinoma (HCC) in assessing recurrence following stereotactic body radiation therapy (SBRT) in patients with HBV-related HCC.

Methods: HBV-related HCC patients who underwent SBRT were retrospectively enrolled from March 2012 to March 2020. Patients were divided into recurrence and non-recurrence groups based on the HCC recurrence situation. Baseline data were collected from all patients before treatment and at 3 and 6 months after treatment, and FIB-4 was calculated at the corresponding time points. Risk factors were selected using Cox regression. The FIB-4 was stratified for survival analysis.

Results: One hundred and fifty-two patients were included. With a mean age of 53.5 years old, 94.1% of them had liver cirrhosis. The median recurrence-free survival (RFS) time for recurrent patients was 17.5 months. The tumor response rate of SBRT was 94.8%. HCC recurrence rates at 12, 24, 36, 48, and 60 months were 19.7% (30/152), 38.2% (58/152), 48.0% (73/152), 52.0% (79/152), and 53.3% (81/152), respectively. Cox regression showed that baseline FIB-4 (95% CI: 1.030 ~ 1.144, p = 0.002) and 3 tumor nodules (95% CI: 3.727 ~ 260.663, p = 0.002) are risk factors for HCC recurrence. Patients with a baseline FIB-4 > 6.55 were at a higher risk of HCC recurrence than those with a baseline FIB-4 < 6.55 (p < 0.001).

Conclusion: Baseline FIB-4 is a risk factor for recurrence after SBRT in patients with HBV-related HCC, and the predictive threshold for FIB-4 is higher in patients with cirrhosis. For patients who received radiotherapy, postoperative FIB-4 levels are elevated.

References

Huang N, Zhang J, Kuang S, Li Z, Zhao H, Wu J . Role of NCF2 as a potential prognostic factor and immune infiltration indicator in hepatocellular carcinoma. Cancer Med. 2023; 12(7):8991-9004. PMC: 10134316. DOI: 10.1002/cam4.5597. View

Fu X, Zhu Y, Zheng B, Zou Y, Wang C, Wu P . KIFC1, a novel potential prognostic factor and therapeutic target in hepatocellular carcinoma. Int J Oncol. 2018; 52(6):1912-1922. PMC: 5919720. DOI: 10.3892/ijo.2018.4348. View

Park L, Tate J, Justice A, Lo Re 3rd V, Lim J, Brau N . FIB-4 index is associated with hepatocellular carcinoma risk in HIV-infected patients. Cancer Epidemiol Biomarkers Prev. 2011; 20(12):2512-7. PMC: 3237927. DOI: 10.1158/1055-9965.EPI-11-0582. View

Sun P, Zhang H, Shi J, Xu M, Cheng T, Lu B . KRTCAP2 as an immunological and prognostic biomarker of hepatocellular carcinoma. Colloids Surf B Biointerfaces. 2023; 222:113124. DOI: 10.1016/j.colsurfb.2023.113124. View

. [Standardization for diagnosis and treatment of hepatocellular carcinoma (2022 edition)]. Zhonghua Gan Zang Bing Za Zhi. 2022; 30(4):367-388. DOI: 10.3760/cma.j.cn501113-20220413-00193. View

Abdi M, Ahmadi A, Mokarizadeh A . Biomarkers for Assessment of Human Immunodeficiency Virus and its Co-Infection with Hepatitis B and Hepatitis C Viruses: A Comprehensive Review. Iran J Pathol. 2023; 18(3):230-243. PMC: 10628369. DOI: 10.30699/IJP.2023.1972384.3009. View

McGlynn K, Petrick J, El-Serag H . Epidemiology of Hepatocellular Carcinoma. Hepatology. 2020; 73 Suppl 1:4-13. PMC: 7577946. DOI: 10.1002/hep.31288. View

Suh B, Park S, Shin D, Yun J, Yang H, Yu S . High liver fibrosis index FIB-4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers. Hepatology. 2014; 61(4):1261-8. DOI: 10.1002/hep.27654. View

Lencioni R, Llovet J . Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010; 30(1):52-60. DOI: 10.1055/s-0030-1247132. View

10.

Bae S, Chun S, Chung J, Kim E, Kang J, Jang W . Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines. Int J Radiat Oncol Biol Phys. 2023; 118(2):337-351. DOI: 10.1016/j.ijrobp.2023.08.015. View

11.

Sonneveld M, Brouwer W, Chan H, Piratvisuth T, Jia J, Zeuzem S . Optimisation of the use of APRI and FIB-4 to rule out cirrhosis in patients with chronic hepatitis B: results from the SONIC-B study. Lancet Gastroenterol Hepatol. 2019; 4(7):538-544. DOI: 10.1016/S2468-1253(19)30087-1. View

12.

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

13.

Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V . FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007; 46(1):32-6. DOI: 10.1002/hep.21669. View

14.

Magne N, Daguenet E, Bouleftour W, Conraux L, Tinquaut F, Grangeon K . Impact of Radiation Therapy on Biological Parameters in Cancer Patients: Sub-analysis from the RIT Prospective Epidemiological Study. Cancer Invest. 2022; 41(2):109-118. DOI: 10.1080/07357907.2022.2139838. View

15.

Kim M, Lee Y, Yoon J, Lee M, Kye S, Kim S . The FIB-4 Index Is a Useful Predictor for the Development of Hepatocellular Carcinoma in Patients with Coexisting Nonalcoholic Fatty Liver Disease and Chronic Hepatitis B. Cancers (Basel). 2021; 13(10). PMC: 8151791. DOI: 10.3390/cancers13102301. View

16.

Hsu H, Yu M, Lee C, Tsai H, Sung C, Chen C . RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma. BMC Cancer. 2017; 17(1):742. PMC: 5680811. DOI: 10.1186/s12885-017-3748-9. View

17.

Lin J, Zhang H, Yu H, Bi X, Zhang W, Yin J . Epidemiological Characteristics of Primary Liver Cancer in Mainland China From 2003 to 2020: A Representative Multicenter Study. Front Oncol. 2022; 12:906778. PMC: 9253580. DOI: 10.3389/fonc.2022.906778. View

18.

Tsai M, Yen Y, Huang P, Sou F, Lin C, Cho W . The Pre- and Postoperative FIB-4 Indexes Are Good Predictors to the Outcomes of HBV-Related HCC Patients after Resection. Gastroenterol Res Pract. 2019; 2019:8945798. PMC: 6914978. DOI: 10.1155/2019/8945798. View

19.

Lin J, Chao T, Hsueh C, Kuo S . High recurrent rate of multicentric papillary thyroid carcinoma. Ann Surg Oncol. 2009; 16(9):2609-16. DOI: 10.1245/s10434-009-0565-7. View

20.

Liao R, Li D, Du C, Li M . Combined Preoperative ALBI and FIB-4 Is Associated with Recurrence of Hepatocellular Carcinoma After Curative Hepatectomy. J Gastrointest Surg. 2018; 22(10):1679-1687. DOI: 10.1007/s11605-018-3810-1. View