title: Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB-4 liver fibrosis index.
abstract: BACKGROUND
  Although heavy alcoholics are at heightened risk for hepatocellular carcinoma (HCC), there are no guidelines that recommend HCC screening for heavy alcoholics. This study investigated FIB-4, a noninvasive and easily applicable liver fibrosis index, as a risk factor for HCC incidence among alcohol drinkers without viral hepatitis.
  
  
  METHODS
  This retrospective cohort study included 6661 generally healthy adults who were 30 years old or older, did not have chronic viral hepatitis, and visited Seoul National University Hospital for a general, routine health evaluation. The future HCC incidence was determined from National Health Insurance medical service claims data (median follow-up, 6.2 years).
  
  
  RESULTS
  With adjustments for age, sex, body mass index, smoking, and alcohol, compared with subjects with FIB-4 values less 1.00, subjects with FIB-4 values greater than or equal to 1.75 and less than 2.10 and subjects with FIB-4 values greater than or equal to 2.10 had adjusted hazard ratios (aHRs) of 5.18 (95% confidence interval [CI], 1.12-24.00) and 13.63 (95% CI, 3.77-49.33), respectively, for HCC incidence. This was heightened in subjects who drank more 30 g of alcohol per day: the aHRs were 8.39 (95% CI, 1.28-54.87) and 16.58 (95% CI, 3.87-71.04), respectively. FIB-4 was shown to have a higher predictive value for HCC incidence than ultrasonographically detected liver cirrhosis (C-index, 0.665 vs 0.527; P = .044).
  
  
  CONCLUSIONS
  High FIB-4 is a risk factor with a high predictive value for HCC incidence, especially among moderate to heavy alcoholics (>30 g/d). FIB-4 is a readily available and probably cost-effective clinical tool with potential value for identifying subpopulations of alcoholics at particularly high risk who would benefit from regular HCC screening. Further investigations are warranted to validate our results; nonetheless, our study suggests that FIB-4 may be useful in HCC screening among alcoholics.
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Beomseok
authors.initials: B
authors.lastname: Suh
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Yun
authors.affiliation: Division of Hematology & Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Sehhoon
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.|Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Hyung-Kook
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Eunmi
authors.initials: E
authors.lastname: Ahn
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.|Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.|Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea.
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism / Q000150:complications*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: alcohol drinking; cancer screening; hepatocellular carcinoma; liver cirrhosis; liver fibrosis index