F. B. Maegawa1,2, L. Shehorn3, J. B. Kettelle1,2, T. S. Riall2 1Southern Arizona VA Health Care System,Department Of Surgery,Tucson, AZ, USA 2University Of Arizona,Department Of Surgery,Tucson, AZ, USA 3Southern Arizona VA Health Care System,Department Of Nursing,Tucson, AZ, USA
Introduction:
The clinical role of non-invasive fibrosis markers (NIFM) on the mortality of patients undergoing hepatectomy for hepatocellular carcinoma (HCC) is not well established. We investigate the long-term impact of NIFM on mortality after hepatectomy for HCC.
Methods:
This analysis utilized the Department of Veterans Affairs Corporate Data Warehouse database between 2000-2012. The severity of hepatic fibrosis was determined by the AST-platelet ratio index (APRI) and the Fibrosis-4 score (FIB-4). Kaplan-Meier survival and Cox proportional hazard regression methods were utilized for analysis.
Results:
Mean age, MELD score, and BMI were 65.6 (SD: ± 9.4) years, 9 (SD: ± 3.1) and 28 (SD: ± 4.9) kg/m2, respectively. Most the patients were white (64.5%), followed by black (27.6%). The most common operation was partial lobectomy (56.5%) followed by right hepatectomy (28.7%). Out of 475 veterans who underwent hepatectomy for HCC, 26.3% had significant fibrosis utilizing APRI (index >1) and 29.2% utilizing FIB-4 (score > 3.25). The long-term survival among veterans with APRI > 1 was significantly worse compared to those with a normal index. Kaplan-Meier survival analysis revealed a median survival of 2.76 vs 4.38 years, respectively (Log-Rank: p< 0.0018). In contrast, the FIB-4 score was not associated with worse survival. Median survival among veterans with FIB-4 > 3.25 compared to those with a normal score was 3.28 vs 4.22 years, respectively (Log-Rank: p = 0.144). Unadjusted Cox proportional hazard regression showed that APRI >1 is associated with increased mortality (HR: 1.45; 95% CI 1.14 – 1.84). After adjusting for age, race, BMI and MELD score, APRI remained associated with increased mortality (HR: 1.36, 95% CI: 1.02 – 1.82). FIB-4 was not associated with increased mortality in both unadjusted and adjusted analysis (HR: 1.19; 95% CI: 0.94 – 1.50 and HR:1.29; 95% CI: 0.96 – 1.72, respectively).
Conclusion:
APRI can be used as a preoperative tool to predict long-term mortality after hepatectomy, refining the selection criteria for liver resection for HCC. These results suggest patients with APRI > 1 are likely to benefit from other curative therapies, such as transplantation.