FIB-4 index for assessing the prognosis of hepatocellular carcinoma in patients with Child-Pugh class A liver function

We evaluated the prognosis of hepatocellular carcinoma (HCC) patients with Child-Pugh (C-P) class A based on FIB-4 index, which is a liver fibrosis marker. A total of 915 HCC patients with C-P class A were investigated. We assessed the prognosis using FIB-4 index, and factors associated with survival rates were analyzed in these patients. When patients were categorized according to FIB-4 index as < 2.0 (n = 93), a parts per thousand yen2.0 and < 4.0 (n = 311), and a parts per thousand yen4.0 (n = 511), survival rates at 5 years were 70.5 % [95 % confidence interval (CI) 59.0-79.9], 56.4 % (95 % CI 50.1-62.5), and 47.1 % (95 % CI 42.2-52.1), respectively. Patients with FIB-4 index < 2.0 had a higher survival rate than the other groups (a parts per thousand yen4.0 vs a parts per thousand yen2.0 and < 4.0, p = 0.010; a parts per thousand yen2.0 and < 4.0 vs < 2.0, p = 0.028). We were able to predict prognosis in patients with C-P score 5 by FIB-4 index, but survival rate did not significantly differ in patients with C-P score 6. Multivariate analysis identified C-P score, FIB-4 index [a parts per thousand yen2.0 and < 4.0; hazard ratios (HRs) 1.638 (95 % CI 1.084-2.474); p = 0.019/a parts per thousand yen4.0; HR 1.828 (95 % CI 1.217-2.744); p = 0.004], Lens culinaris agglutinin-reactive alpha-fetoprotein, tumor size, number, vascular invasion, antiviral therapy, and hepatectomy as independent predictive factors for survival. The FIB-4 index is useful for assessing prognosis in HCC patients with C-P class A, especially those with C-P score 5.