Prevalence of Low FIB‐4 in MASLD‐Related Hepatocellular Carcinoma: A Multicentre Study
Darren Jun Hao Tan, Nobuharu Tamaki, Beom Kyung Kim, Karn Wijarnpreecha, Majd B. Aboona, Claire Faulkner, Charlotte Kench, Shirin Salimi, Abdul‐Hamid Sabih, Wen Hui Lim, Pojsakorn Danpanichkul, Benjamin Tay, Yiqing Teh, John Mok, Benjamin Nah, Cheng Han Ng, Mark Muthiah, Anand V. Kulkarni, Sung Won Lee, Ken Liu, Rohit S. Loomba, Daniel Q. Huang
Abstract
BACKGROUND: Major society guidelines recommend the fibrosis-4 index (FIB-4) as the initial step to risk stratifying people with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to evaluate the proportion of people with MASLD-related hepatocellular carcinoma (HCC) and a low FIB-4. METHODS: This cohort study included 613 consecutive adults (33% female) diagnosed with MASLD-related HCC from January 2008 to August 2023 at seven international centres in Australia, India, Japan, South Korea, Singapore and the United States. The primary objective was to determine the proportion of participants with a low FIB-4, defined as FIB-4 < 1.3, or < 2 if age > 65 years, in people without cirrhosis. RESULTS: , respectively. Overall, 235 participants (38%) did not have known cirrhosis. The median FIB-4 was 3.90 (IQR 2.42-6.42). A total of 78 participants (13%) had a low FIB-4. Among participants without known cirrhosis (n = 235), 62 participants (26%) had a low FIB-4. Participants with a low FIB-4 had larger median total tumour diameter (p < 0.001) and lower median serum alpha-fetoprotein (p = 0.005), compared to participants without a low FIB-4. Cirrhosis was associated with lower odds of low FIB-4, but not other factors such as male sex, type 2 diabetes, or obesity. CONCLUSION: More than a quarter of those with MASLD-related HCC without cirrhosis have a low FIB-4. The proposed clinical care pathways may not identify these people for further evaluation.