Identification of high-risk group for diabetes-associated hepatocellular carcinoma using noninvasive test for liver fibrosis.

Background: As diabetes-associated hepatocellular carcinoma (DM-HCC) has surged in Japan, there is an urgent need for effective screening methods. The Fibrosis-4 (FIB-4) index is commonly used for screening, but its age component tends to yield false-positive results in older patients. This study aimed to evaluate the value of the newly developed Fibrosis-3 (FIB-3) index, which excludes age, for identifying high-risk groups for DM-HCC across all age groups.

Methods: This study included 174 patients with diabetes-associated Barcelona Clinic Liver Cancer stage 0 hepatocellular carcinoma (HCC) and 74 diabetic controls. The ability of the FIB-4 and FIB-3 indices to predict HCC risk was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression analyses.

Results: Both indices effectively identified high-risk groups for DM-HCC (area under the ROC curve: FIB-4, 0.909; FIB-3, 0.911). Notably, the FIB-4 index required age-adjusted cutoffs, whereas a single cutoff FIB-3 maintained its predictive ability across all age groups. Multivariate analysis confirmed FIB-3 as an independent predictor of HCC risk even after adjusting for factors such as BMI, liver function tests, and tumor markers.

Conclusion: The FIB-3 index is a promising tool for identifying high-risk groups for DM-HCC without age-dependent cutoffs, potentially enabling earlier diagnosis and better prognosis. Its ability to stratify risk consistently across age groups addresses the limitations of FIB-4.