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Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB ‐4 liver fibrosis index
Author(s) -
Suh Beomseok,
Yun Jae Moon,
Park Sehhoon,
Shin Dong Wook,
Lee Tae Hoon,
Yang HyungKook,
Ahn Eunmi,
Lee Hyejin,
Park Jin Ho,
Cho BeLong
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29577
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , incidence (geometry) , cirrhosis , liver cancer , cohort , body mass index , viral hepatitis , hepatitis c , risk factor , confidence interval , gastroenterology , physics , optics
BACKGROUND Although heavy alcoholics are at heightened risk for hepatocellular carcinoma (HCC), there are no guidelines that recommend HCC screening for heavy alcoholics. This study investigated FIB‐4, a noninvasive and easily applicable liver fibrosis index, as a risk factor for HCC incidence among alcohol drinkers without viral hepatitis. METHODS This retrospective cohort study included 6661 generally healthy adults who were 30 years old or older, did not have chronic viral hepatitis, and visited Seoul National University Hospital for a general, routine health evaluation. The future HCC incidence was determined from National Health Insurance medical service claims data (median follow‐up, 6.2 years). RESULTS With adjustments for age, sex, body mass index, smoking, and alcohol, compared with subjects with FIB‐4 values less 1.00, subjects with FIB‐4 values greater than or equal to 1.75 and less than 2.10 and subjects with FIB‐4 values greater than or equal to 2.10 had adjusted hazard ratios (aHRs) of 5.18 (95% confidence interval [CI], 1.12‐24.00) and 13.63 (95% CI, 3.77‐49.33), respectively, for HCC incidence. This was heightened in subjects who drank more 30 g of alcohol per day: the aHRs were 8.39 (95% CI, 1.28‐54.87) and 16.58 (95% CI, 3.87‐71.04), respectively. FIB‐4 was shown to have a higher predictive value for HCC incidence than ultrasonographically detected liver cirrhosis (C‐index, 0.665 vs 0.527; P = .044). CONCLUSIONS High FIB‐4 is a risk factor with a high predictive value for HCC incidence, especially among moderate to heavy alcoholics (>30 g/d). FIB‐4 is a readily available and probably cost‐effective clinical tool with potential value for identifying subpopulations of alcoholics at particularly high risk who would benefit from regular HCC screening. Further investigations are warranted to validate our results; nonetheless, our study suggests that FIB‐4 may be useful in HCC screening among alcoholics. Cancer 2015;121:3818–3825. © 2015 American Cancer Society .