Fibrosis Markers Tied to Mortality After Liver Cancer Surgery

By David Douglas

January 29, 2019

NEW YORK (Reuters Health) - Noninvasive markers of fibrosis are associated with perioperative mortality and survival after liver resection for hepatocellular carcinoma, a retrospective study suggests.

Such markers can improve selection criteria, Dr. Felipe B. Maegawa told Reuters Health by email. Moreover, "Resection remains as the preferred therapy for this disease, but it can be associated with significant morbidity and mortality if offered to the wrong patient. Tumor ablation and transplant are excellent curative alternatives."

As reported January 18 online in JAMA Network Open, Dr. Maegawa of Southern Arizona Veterans Affairs Health Care System, Tucson, and colleagues analyzed the utility of aspartate aminotransferase-platelet ratio index (APRI) and fibrosis 4 (Fib4) values in 475 patients who underwent hepatectomy between 2000 and 2012. Most (67.6%) had partial lobectomies.

Compared to an APRI of 1.5 or less, higher scores were associated with higher mortality at 30 days (odds ratio, 6.45) and 90 days (OR, 2.65). This was also the case for a Fib4 above 4.0, with a 30-day mortality OR of 5.41 and a 90-day OR of 2.74.

Mean overall survival was also significantly less in the higher APRI group (3.6 versus 5.4 years) and the higher Fib4 group (4.1 versus 5.3 years). However, further analysis showed that elevated APRI was significantly associated with worse survival but that Fib4 values were not.

Commenting by email, Dr. Scott L. Friedman, Chief of the Division of Liver Diseases of the Icahn School of Medicine at Mount Sinai, New York City, told Reuters Health, "These tests are used in clinical practice as approximate markers of fibrosis stage, so it is not surprising that they correlate (with) outcomes as well, as fibrosis stage is also linked to outcomes, especially when portal hypertension is already present (i.e., very advanced disease)."

Indeed, added Dr. Friedman, "increased portal hypertension was also associated in this study with increased mortality to the same extent in these patients. In aggregate, the findings reinforce earlier studies indicating that non-invasive markers of this type may help identify high risk patients undergoing liver resection."

"This information," he concluded, "should be integrated into an overall clinical assessment, including whether portal hypertension is present, when determining who may be suitable, and what the risk is of liver resection for hepatocellular carcinoma."


JAMA Netw Open 2019.