Posttreatment FIB-4 score change predicts hepatocellular carcinoma in chronic hepatitis C patients: Findings from the Taiwan hepatitis C registry program

Hung-Wei Wang ¹, Yu-Syuan Zeng ², Chung-Feng Huang ²

¹School of Medicine, China Medical University, Taichung, Taiwan; Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
²Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan.
⁴Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁵Department of Internal Medicine, Dalin Tzu Chi Hospital, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
⁶Tainan Municipal Hospital, Tainan, Taiwan.
⁷Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan; College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁹Division of Hepatogastroenterology, Department of Internal Medicine, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan.
¹⁰Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan.
¹¹Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan.
¹²Liouying Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹³Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, Taiwan.
¹⁴Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Taipei, Taiwan.
¹⁵Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁶Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁷Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
¹⁸Liver Research Unit, Department of Hepato-Gastroenterology and Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Chang Gung University, College of Medicine, Keelung, Taiwan.
¹⁹Liver Center, Cathay General Hospital, Taiwan.
²⁰Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
²¹Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
²²Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
²³Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
²⁴Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taiwan; Mackay Medical College, New Taipei City, Taiwan.
²⁵Division of Gastroenterology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.
²⁶Division of Gastroenterology, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan.
²⁷Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²⁸Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taiwan.
²⁹Department of Gastroenterology and Hepatology, Changhua Christian Hospital, Taiwan.
³⁰Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, and School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
³¹Department of Gastroenterology, Renai Branch, Taipei City Hospital, Taipei, Taiwan.
³²MacKay Memorial Hospital, Taipei, Taiwan.

⁰School of Medicine, China Medical University, Taichung, Taiwan; Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi +

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March 1, 2025

View abstract on PubMed

Summary

The Fibrosis-4 (FIB-4) score and its change after treatment predict hepatocellular carcinoma (HCC) risk in chronic hepatitis C (CHC) patients receiving direct-acting antivirals (DAAs). These scores help stratify patients for HCC development risk post-treatment.

Area Of Science

Hepatology
Viral Hepatitis Research
Oncology

Background

Direct-acting antivirals (DAAs) have revolutionized chronic hepatitis C (CHC) treatment, leading to high sustained virologic response (SVR) rates.
However, the risk of hepatocellular carcinoma (HCC) persists even after viral clearance in some patients.
Identifying patients at high risk for HCC post-treatment is crucial for effective management.

Purpose Of The Study

To investigate the predictive value of the Fibrosis-4 (FIB-4) score and its change for HCC development in CHC patients treated with DAAs.
To determine if baseline and post-treatment FIB-4 scores can stratify HCC risk in this population.

Main Methods

Analysis of 9679 CHC patients who achieved SVR after DAA treatment from the Taiwan Nationwide Real-World HCV Registry Program.
Multivariable Cox regression was used to identify predictors of HCC, including baseline characteristics and post-SVR FIB-4 score and its change (△FIB-4).

Main Results

Diabetes mellitus, baseline alpha-fetoprotein (AFP) level, and FIB-4 score were independent predictors of HCC.
A significant reduction in FIB-4 score (△FIB-4 < -0.9086) from baseline to SVR was also a predictor of HCC.
Post-SVR FIB-4 score (≥3.25) and significant FIB-4 reduction (△FIB-4 < -0.9086) were associated with substantially higher 3-year cumulative HCC incidence.

Conclusions

The post-treatment FIB-4 score and its change from baseline are valuable tools for stratifying HCC risk in CHC patients receiving DAAs.
These non-invasive markers can aid in identifying patients who require closer surveillance for HCC development.

Keywords:

Chronic hepatitis C (CHC) Direct-acting antivirals (DAAs) FIB-4 Hepatocellular carcinoma (HCC)

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