J Hepatocell Carcinoma: Age, glutamine aminotransferase, and platelet index: a novel noninvasive model for predicting hepatocellular carcinoma in patients with hepatitis B virus-associated hepatitis

Background: Hepatocellular carcinoma accounts for 90% of liver cancers and is therefore a major health burden
in Asia.
Chronic hepatitis B virus or hepatitis C virus infection is the dominant process in the development and development of
hepatocellular carcinoma.
Although antiviral drugs can reduce the risk of hepatocellular carcinoma, the incidence of hepatocellular carcinoma remains high
in patients with cirrhosis (LC).
Hepatic fibrosis is a major risk factor for
hepatocellular carcinoma.
The Noninvasive Scoring System (NSSS), which includes fibrin-4 (FIB-4), aminotransferase/platelet ratio (APRI), and γ-glutamyl transpeptidase/platelet ratio (GPR), provides moderate accuracy in the assessment of liver fibrosis and adequately predicts long-term prognosis
.
FIB-4 is a valuable and dangerous marker for the development of
hepatocellular carcinoma after hepatitis C eradication.
Data from a small study suggest that a combination of APRI and alpha-fetoprotein (AFP) can predict the development of
hepatocellular carcinoma in patients with hepatitis C virus-associated decompensated cirrhosis (DC).

For patients with chronic hepatitis B (CHB), both FIB-4 and APRIs can be used to predict the development of
hepatocellular carcinoma.
FIB-4 is superior to pre-treatment FIB-4
at 1 year of treatment in predicting liver cancer.
However, another study showed that elevated FIB-4 does not serve as a reliable indicator
of risk stratification for hepatocellular carcinoma in non-Asian CHB patients.
Data from West Africa show that an APRI score of >2 has a sensitivity of only 45.
4%
for diagnosing cirrhosis.
In patients who develop hepatocellular carcinoma, APRI is maintained at a high level
.
Nishikawa et al.
report that FIB-4 rather than APRI may be a valuable predictor of
liver cancer development in CHB patients treated with entecavir.
APRI in combination with FIB-4 can stratify
hepatocellular carcinoma in CHB patients with low viremia.
Zhu et al.
reported that GPR was better
than FIB-4 in predicting hepatocellular carcinoma progression in elderly CHB patients.
It is important to note that the NSSS for HBV-associated DC is limited
.

Objective: To evaluate the predictive power of fibrinogen-4 (FIB-4), transaminase/platelet ratio (APRI) and γ-glutamyl transpeptidase/platelet ratio (GPR) in LC patients, and to establish a new and more accurate model
.

Methods: The clinical data
of 94 patients with compensated LC and 134 patients with decompensated cirrhosis were collected.
The prediction accuracy
of APRI, GPR and FIB-4 NSSS models was compared.

Results: During the median follow-up period of 37.
5 months, 9 patients in the compensated LC group developed hepatocellular carcinoma and 38 patients in the DC group
.
The areas under the receiver operating characteristic curves of APRI, GPR, and FIB-4 were 0.
596, 0.
625, and 0.
654
, respectively.
Multivariate logistic regression analysis showed that age, γ-glutamyl transpeptidase (GGT) and platelets (PLT) were independent risk factors for liver cancer, and the new model combining age, GGT and PLT was better than the NSSS model (all P<0.
05).

The optimal cutoff value is 0
.
The sensitivity of the model (Age_GGT_PLT) was 68.
09% and the specificity was 69.
61%.

Table Two risk factors for liver cancer in patients with cirrhosis

Figure 1 AUROC comparison
between model (Age_GGT_PLT) and NSSS.
(A) general population, (B) compensatory LC patients, (C) DC patients
.
Abbreviation: AUROC, area under the subject's operating characteristic curve; NSS, non-invasive scoring system; DC, decompensated cirrhosis; LC, cirrhosis; GGT,γ-glutamyltransferase; PLT, platelets; GPR, γ-glutamyl transpeptidase to plate ratio; APRI, aspartate aminotransferase to platelet ratio index; FIB-4, fibrosis-4 index
.

Figure 2 Correlation analysis
between model (Age_GGT_PLT), NSSS, MELD, and AFP.
(A) general population, (B) compensatory LC patients, (C) DC patients
.
Abbreviation: NSSS, non-invasive scoring system; MELD, model of end-stage liver disease; AFP, alpha-fetoprotein; GGT, γ-glutamyl transpeptidase; PL T, platelets
.

Figure 3 Kaplan-Meier analysis
of a patient model (Age_GGT_PLT) of cirrhosis.
(A) general population, (B) compensatory LC patients, (C) DC patients
.
Abbreviation: LC, cirrhosis; DC, decompensated cirrhosis; GGT, γ-glutamyl transpeptidase; PLT, platelets
.

Conclusions: NSSS, including APRI, GPR, and FIB-4, is not accurate
in predicting hepatocellular carcinoma progression in patients with hepatitis B-associated LC.
Therefore, the new model, consisting of age, GGT, and PLT, may be more accurate
than NSSS.

Original source: Liu K, Huang Z, Yang S,et al.
The Age, Gamma-Glutamyl Transpeptidase and Platelet Index: A Novel Noninvasive Model for Predicting Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Liver Cirrhosis.
J Hepatocell Carcinoma 2022; 9