| Title: | Non-invasive tests to guide hepatocellular carcinoma surveillance |
| Journal: | JHEP Reports |
| Published: | 23 Jan 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41783363/ |
| DOI: | https://doi.org/10.1016/j.jhepr.2026.101739 |
Publication 18484
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Abstract
Background & Aims: Current guidelines recommend hepatocellular carcinoma (HCC) surveillance for patients with cirrhosis, though guidance on the use of non-invasive tests is lacking. Patients with compensated advanced chronic liver disease, defined non-invasively by liver stiffness measurement (LSM) ≥10 kPa, are at increased risk of hepatic decompensation and HCC. Although a fibrosis-4 (FIB-4) score ≥1.75 aligns with LSM ≥10 kPa in tertiary care, its utility for guiding HCC surveillance remains unclear. This study assessed the accuracy of FIB-4 vs. LSM in predicting HCC risk.</p>
Methods: We retrospectively analyzed 6,143 patients with suspected chronic liver disease undergoing FIB-4 and LSM between 2007 and 2020 in Vienna. External validation was performed in participants from the UK Biobank with pre-existing liver disease. Patients were stratified by FIB-4 cut-offs (1.75 and 2.67) and corresponding LSM thresholds (10 kPa and 15 kPa).</p>
Results: FIB-4 predicted de novo HCC with AUROCs of 0.79 (95% CI 0.65-0.94) at 1 year and 0.85 (95% CI 0.76-0.94) at 2 years, comparable to LSM. Two-year HCC incidence was 0.10% vs. 1.05% (0.05 vs. 0.53/100 person-years) for FIB-4 <1.75 vs. ≥1.75 (subdistribution hazard ratio 15.5, 95% CI 8.2-29.2), and 0.13% vs. 1.75% (0.07 vs. 0.89/100 person-years) for ≤2.67 vs. >2.67. Among UK Biobank participants with pre-existing liver disease, the 5 year cumulative incidence of HCC was 3.7% vs. 0% for FIB-4 ≥1.75 vs. <1.75 and 7.1% vs. 0.5% for >2.67 vs. ≤2.67.</p>
Conclusions: FIB-4 (≥1.75 and >2.67) shows similar ability to predict HCC development as LSM (≥10 kPa and ≥15 kPa) in tertiary care and population-based cohorts. FIB-4 may serve as a practical tool to guide HCC surveillance.</p>
Impact and implications: This study addresses the need for easily accessible non-invasive tools to stratify hepatocellular carcinoma risk in patients with (suspected) chronic liver disease and shows that the universally available fibrosis-4 (FIB-4) score performs comparably to liver stiffness measurement (LSM) across clinically relevant thresholds. FIB-4 ≥1.75 or LSM ≥10 kPa identify patients at risk, although thresholds of >2.67 or ≥15 kPa may be required for cost-effectiveness beyond a specialist setting. In clinical practice, physicians may use FIB-4 to guide hepatocellular carcinoma surveillance where LSM is unavailable. Researchers and policymakers can leverage these findings to develop risk-adapted surveillance strategies.</p>
19 Authors
- Jan Embacher
- Katharina Remih
- Carolin Victoria Schneider
- Mathias Jachs
- Lorenz Balcar
- Paul Thöne
- Christian Sebesta
- Nina Dominik
- Georg Kramer
- Benedikt Silvester Hofer
- Lukas Hartl
- Benedikt Simbrunner
- Bernhard Scheiner
- Matthias Pinter
- Michael Trauner
- Thomas Reiberger
- Pavel Strnad
- Georg Semmler
- Mattias Mandorfer
1 Application
| Application ID | Title |
|---|---|
| 148742 | Multiomic signature of digestive disorders |
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