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1 Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
2 Department of Internal Medicine, Division of Hematology & Medical Oncology, Seoul National University Hospital, Seoul, Republic of Korea
3 Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
4 Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
5 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
6 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
7 Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
†
These authors contributed equally.
*CORRESPONDING AUTHOR: Dong Wook Shin, M.D., Dr.P.H., M.B.A., Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Cancer Survivorship Clinic, Seoul National University Cancer Hospital, 101 Daehakro, Jongnogu, Seoul 110-744, Republic of Korea, Tel: +82-2-2072-0847, Fax: +82-2-766-3276, E-mail: [email protected]
ABSTRACT
Screening for hepatocellular carcinoma (HCC) is clinically important as its early detection has remarkable survival benefits. We investigated the possible role of FIB-4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers aged 40 or older who visited Seoul National University Hospital for health check-up. National medical service claims data was used to determine HCC incidence. Median follow-up time was 5.4 years (interquartile range 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and anti-viral medication for hepatitis B, compared to subjects with FIB-4 <1.25, subjects with 1.7≤ FIB-4 <2.4 showed aHR 4.57 (95% CI 1.50-13.92) and subjects with FIB-4 ≥2.4 showed aHR 21.34 (95% CI 7.73-58.92) for HCC incidence. FIB-4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C-index 0.701 vs. 0.831; P=0.001). FIB-4 was also better predictive of HCC incidence compared to that of ultrasonographic liver cirrhosis (C-index 0.775 vs. 0.701; P=0.040).
Conclusion: High FIB-4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB-4 is a promising, easily applicable, and cost-effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests FIB-4 may play a valuable role in HCC screening among HBsAg carriers. This article is protected by copyright. All rights reserved.
筛查肝细胞癌(HCC)是临床上重要的,因为它的早期发现具有显着的生存益处。我们研究的FIB-4,最近开发的非侵入性标记物的基础上常规化验肝纤维化的可能的作用,作为临床指标预测中B型肝炎表面抗原(HBsAg)携带者未来肝癌。我们回顾性队列研究涉及谁访问了首尔大学医院健康体检40岁以上986韩国HBsAg携带者。国家医疗服务索赔数据来确定HCC发生率。平均随访时间为5.4年(四分范围4.4年)。调整年龄,性别,身体质量指数,吸烟,饮酒,以及抗病毒的药物为乙型肝炎,相比受试者FIB-4<1.25,受试者1.7≤FIB-4<2.4表明AHR4.57(95%CI:1.50 -13.92)和科目与FIB-4≥2.4显示AHR21.34(95%CI7.73-58.92),肝癌的发病率。 FIB-4被证明有增量的预测值超声肝硬化肝癌发病率(C-指数0.7010.831对比; P =0.001)。 FIB-4也是较好的预测肝癌发生的相比,超声波诊断肝硬化(C-指数0.775与0.701; P =0.040)。