Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD

Mònica Pons; Jesús Rivera-Esteban; Ramiro Manzano; Juan Bañares; María Bermúdez; Víctor Vargas; Maria Teresa Salcedo-Allende; Lluís Castells; Salvador Augustin; Beatriz Mínguez; Juan M Pericàs

doi:10.3390/jcm11092466

Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD

J Clin Med. 2022 Apr 27;11(9):2466. doi: 10.3390/jcm11092466.

Authors

Mònica Pons^{1

2}, Jesús Rivera-Esteban^{1

2

3}, Ramiro Manzano^{1

2}, Juan Bañares^{1

2}, María Bermúdez^{1

2}, Víctor Vargas^{1

2

3

4}, Maria Teresa Salcedo-Allende^{3

5}, Lluís Castells^{1

2

3

4}, Salvador Augustin^{1

2

4}, Beatriz Mínguez^{1

2

3

4}, Juan M Pericàs^{1

2

4}

Affiliations

¹ Liver Unit, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.
² Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, 08035 Barcelona, Spain.
³ Faculty of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain.
⁴ Centro de Investigación Biomédica en Red de Enfermedades Digestivas y Hepáticas (CIBERehd), 28029 Madrid, Spain.
⁵ Pathology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.

Abstract

Background: The potential role of non-invasive tests (NITs) for liver fibrosis for hepatocellular carcinoma (HCC) prediction remains poorly known. Methods: Retrospective analysis of a NAFLD cohort from a single university hospital in Barcelona, Spain. Incidence rates and cumulative incidence for the overall cohort, as well as cirrhotic and non-cirrhotic patients were calculated. Logistic regression analyses were carried out to investigate risk factors of HCC. Results: From the entire cohort of 1040 patients, 996 patients (95.8%) were analyzed, in whom 35 cases of HCC were detected, of which 26 (72.4%) HCC incident cases were newly diagnosed during a median follow-up of 2.5 (1.9−3.6) years. Two-hundred and thirty-one (23.2%) were cirrhotic at baseline. With the exception of 2 (7.7%) cases of HCC, the rest were diagnosed in cirrhotic patients. Overall HCC cumulative incidence was 9.49 (95% CI 6.4−13.9) per 1000 person-years. The incidence rate for cirrhotic patients was 41.2 (95% CI 27.6−61.6) per 1000 person-years and 0.93 (95% CI 0.23−3.7) per 1000 person-years for patients without cirrhosis. Overall mortality was significantly higher amongst patients with HCC (4.4% vs. 30.8%, p < 0.001). In patients with available liver biopsy (n = 249, 25%), advanced fibrosis (F3−F4) was significantly associated with higher HCC incidence, but not steatosis, lobular inflammation, nor ballooning. In the overall cohort, FIB-4 ≥1.3 (HR 8.46, 95% CI 1.06−67.4, p = 0.044) and older age (HR 1.06, 95% CI 1.01−1.11, p = 0.025) were associated with increasing risk of HCC over time, whereas in cirrhotic patients predictors of HCC included decreasing values of albumin (HR 0.34, 95% CI 0.13−0.87, p = 0.024), platelets (HR 0.98, 95% CI 0.98−0.99, p = 0.001), and increasing values of liver stiffness (HR 1.03, 95% CI 1.00−1.06, p = 0.016). Conclusions: In a Spanish cohort of NAFLD patients, HCC was rare in non-cirrhotic patients. NITs might play a relevant role at predicting HCC.

Keywords: FIB-4; NAFLD; hepatocellular carcinoma; transient elastography.

Grants and funding

This research received no external funding.