Potential role of fibrosis-4 score in hepatocellular carcinoma screening: The Kangbuk Samsung Health Study

Sujeong Shin, Won Sohn, Yoosoo Chang*, Yoosun Cho, Min-Jung Kwon, Sarah H Wild, Christopher D Byrne, Seungho Ryu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Aim: Hepatocellular carcinoma (HCC) is a major cause of cancer-related death, with low survival rates worldwide. Fatty liver disease (FLD) significantly contributes to HCC. We studied the screening performance of different methods for identifying HCC in patients with FLD or with metabolic risk factors for FLD.
Methods: Korean adults (n=340,825) without a prior HCC diagnosis were categorized into four groups: normal (G1), ≥2 metabolic risk factors (G2), FLD (G3), and viral liver disease or liver cirrhosis (G4). The National Cancer Registry data were used to identify HCC cases within 12 months. We assessed the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and positive and negative predictive values of individual or combined screening methods.
Results: In 93 HCC cases, 71 were identified in G4, while 20 cases (21.5%) in G2 and G3 combined where ultrasound and fibrosis-4 performed similarly to alpha-fetoprotein and ultrasound. In G2, fibrosis-4 and ultrasound had the highest AUROC (0.93 [0.87–0.99]), whereas in G3, the combined screening methods had the highest AUROC (0.98 [0.95–1.00]). The positive predictive value was lower in G2 and G3 than in G4 but was >5% when restricted to a high fibrosis-4 score.
Conclusions: More than 21% of HCC cases were observed in patients with diagnosed FLD or at risk of FLD with metabolic risk factors. Nevertheless, screening for HCC in individuals without cirrhosis or viral hepatitis yielded very low results, despite the potential value of the fibrosis-4 score in identifying individuals at high risk of HCC.

KEYWORDS: alpha-fetoprotein, fatty liver disease, fibrosis-4, hepatocellular carcinoma, liver ultrasound
Original languageEnglish
Number of pages11
JournalHepatology Research
Early online date22 Dec 2023
Publication statusE-pub ahead of print - 22 Dec 2023

Keywords / Materials (for Non-textual outputs)

  • alpha‐fetoprotein
  • fatty liver disease
  • Fibrosis-4
  • hepatocellular carcinoma
  • liver ultrasound


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