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

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

doi:10.3390/jcm11092466

Open AccessArticle

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

by

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

and

Juan M. Pericàs

^1,2,4,*

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

^*

Authors to whom correspondence should be addressed.

J. Clin. Med. 2022, 11(9), 2466; https://doi.org/10.3390/jcm11092466

Submission received: 4 April 2022 / Revised: 24 April 2022 / Accepted: 25 April 2022 / Published: 27 April 2022

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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

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MDPI and ACS Style

Pons, M.; Rivera-Esteban, J.; Manzano, R.; Bañares, J.; Bermúdez, M.; Vargas, V.; Salcedo-Allende, M.T.; Castells, L.; Augustin, S.; Mínguez, B.; et al. Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD. J. Clin. Med. 2022, 11, 2466. https://doi.org/10.3390/jcm11092466

AMA Style

Pons M, Rivera-Esteban J, Manzano R, Bañares J, Bermúdez M, Vargas V, Salcedo-Allende MT, Castells L, Augustin S, Mínguez B, et al. Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD. Journal of Clinical Medicine. 2022; 11(9):2466. https://doi.org/10.3390/jcm11092466

Chicago/Turabian Style

Pons, Mònica, Jesús Rivera-Esteban, Ramiro Manzano, Juan Bañares, María Bermúdez, Víctor Vargas, Maria Teresa Salcedo-Allende, Lluís Castells, Salvador Augustin, Beatriz Mínguez, and et al. 2022. "Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD" Journal of Clinical Medicine 11, no. 9: 2466. https://doi.org/10.3390/jcm11092466

APA Style

Pons, M., Rivera-Esteban, J., Manzano, R., Bañares, J., Bermúdez, M., Vargas, V., Salcedo-Allende, M. T., Castells, L., Augustin, S., Mínguez, B., & Pericàs, J. M. (2022). Non-Invasive Tests of Liver Fibrosis Help in Predicting the Development of Hepatocellular Carcinoma among Patients with NAFLD. Journal of Clinical Medicine, 11(9), 2466. https://doi.org/10.3390/jcm11092466

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

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