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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 11
Nov.  2023
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Article Contents

Value of fibrosis-4 combined with prognostic nutritional index in predicting recurrence and survival time after radiofrequency ablation for early-stage hepatocellular carcinoma

DOI: 10.3969/j.issn.1001-5256.2023.11.015
Research funding:

‍Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-034A)

More Information
  • Corresponding author: LIANG Jing, haolele77@sina.com (ORCID: 0000-0001-5114-9030)
  • Received Date: 2023-02-20
  • Accepted Date: 2023-03-15
  • Published Date: 2023-11-28
  •   Objective  To investigate the value of preoperative fibrosis 4 score (FIB-4) combined with prognostic nutritional index (PNI) in predicting recurrence after radiofrequency ablation (RFA) for early-stage hepatocellular carcinoma (HCC).  Methods  A retrospective analysis was performed for the clinical data of 365 patients with the initial diagnosis of early-stage HCC who underwent RFA at Tianjin Third Central Hospital from January 2013 to December 2017, and a statistical analysis was performed for recurrence and survival. The receiver operating characteristic (ROC) curve was plotted for FIB-4 and PNI with postoperative tumor recurrence as the positive event, and their optimal cut-off values were selected. FIB-4 and PNI were graded and combined as FIB-4-PNI score, based on which the patients were divided into 0-point group with 207 patients, 1-point group with 93 patients, and 2-point group with 65 patients. The chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier survival analysis and the log-rank test were used to compare the recurrence-free survival (RFS) and overall survival (OS) between groups, and the Cox regression model was used to investigate the influencing factors for RFS and OS.  Results  The 1-, 3-, and 5-year RFS rates of all patients were 79.2%, 49.8%, and 34.3%, respectively, with a median RFS of 35 months, while the 1-, 3-, and 5-year OS rates of all patients were 98.9%, 86.9%, and 77.3%, respectively. There were significant differences in cumulative RFS and OS rates between the patients with different levels of FIB-4, PNI, and FIB-4-PNI (RFS rate: χ2=17.890, 29.826, and 32.397, all P<0.001; OS rate: χ2=16.896, 21.070, and 26.121, all P<0.001). The multivariate Cox regression analysis showed that history of diabetes (hazard ratio [HR]=1.418, 95% confidence interval [CI]: 1.046‍ ‍—‍ ‍1.922, P=0.024), two tumors (HR=1.516, 95%CI: 1.094‍ ‍—‍ ‍2.101, P=0.012), three tumors (HR=2.146, 95%CI: 1.278‍ ‍—‍ ‍3.604, P=0.004), FIB-4-PNI 1 point (HR=1.875, 95%CI: 1.385‍ ‍—‍ ‍2.539, P<0.001), and FIB-4-PNI 2 points (HR=2.35, 95%CI: 1.706‍ ‍—‍ ‍3.236, P<0.001) were independent risk factors for RFS, while two tumors (HR=1.732, 95%CI: 1.005‍ ‍—‍ ‍2.983, P=0.048), three tumors (HR=3.511, 95%CI: 1.658‍ ‍—‍ ‍7.433, P=0.001), FIB-4-PNI 1 point (HR=2.094, 95%CI: 1.230‍ ‍—‍ ‍3.565, P=0.006), and FIB-4-PNI 2 points (HR=3.908, 95%CI: 2.306‍ ‍—‍ ‍6.624, P<0.001) were independent risk factors for OS.  Conclusion  FIB-4-PNI score can be used as an independent predictive factor for recurrence and overall survival time after RFA for early-stage HCC, and it can be combined with tumor features to predict postoperative recurrence and survival.

     

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