Baseline FIB-4 May Be a Risk Factor of Recurrence After SBRT in Patients With HBV-Related Small HCC.

Aims: Exploring fibrosis index-4 (FIB-4)'s predictive value for HBV-related hepatocellular carcinoma (HCC) in assessing recurrence following stereotactic body radiation therapy (SBRT) in patients with HBV-related HCC.

Methods: HBV-related HCC patients who underwent SBRT were retrospectively enrolled from March 2012 to March 2020. Patients were divided into recurrence and non-recurrence groups based on the HCC recurrence situation. Baseline data were collected from all patients before treatment and at 3 and 6 months after treatment, and FIB-4 was calculated at the corresponding time points. Risk factors were selected using Cox regression. The FIB-4 was stratified for survival analysis.

Results: One hundred and fifty-two patients were included. With a mean age of 53.5 years old, 94.1% of them had liver cirrhosis. The median recurrence-free survival (RFS) time for recurrent patients was 17.5 months. The tumor response rate of SBRT was 94.8%. HCC recurrence rates at 12, 24, 36, 48, and 60 months were 19.7% (30/152), 38.2% (58/152), 48.0% (73/152), 52.0% (79/152), and 53.3% (81/152), respectively. Cox regression showed that baseline FIB-4 (95% CI: 1.030 ~ 1.144, p = 0.002) and 3 tumor nodules (95% CI: 3.727 ~ 260.663, p = 0.002) are risk factors for HCC recurrence. Patients with a baseline FIB-4 > 6.55 were at a higher risk of HCC recurrence than those with a baseline FIB-4 < 6.55 (p < 0.001).

Conclusion: Baseline FIB-4 is a risk factor for recurrence after SBRT in patients with HBV-related HCC, and the predictive threshold for FIB-4 is higher in patients with cirrhosis. For patients who received radiotherapy, postoperative FIB-4 levels are elevated.