Prognostic value of combined FIB-4 and AFP in predicting survival after hepatectomy for hepatocellular carcinoma: a multicenter cohort study.

BACKGROUND

Accurate prognostic assessment remains challenging in patients with hepatocellular carcinoma (HCC). Although the fibrosis-4 (FIB-4) index is widely used for non-invasive evaluation of liver fibrosis, its prognostic value in HCC remains uncertain. This study evaluates the prognostic utility of the FIB-4 index, alpha-fetoprotein (AFP), and the combined AFP-FIB-4 score for long-term survival in patients with HCC following hepatectomy.

METHODS

A retrospective analysis was conducted on 1174 HCC patients who underwent hepatectomy at the First People's Hospital of Changde City and Guangxi Medical University Cancer Hospital between 2014 and 2024. Survival analysis, Cox regression, and receiver operating characteristic (ROC) curve analysis were employed to assess the predictive performance of the FIB-4 index, AFP, and the combined AFP-FIB-4 score for long-term survival.

RESULTS

Multivariate Cox regression analysis demonstrated that the FIB-4 index was not an independent predictor of disease-free survival (DFS) or overall survival (OS) in HCC patients. In contrast, AFP emerged as an independent risk factor for both DFS (HR = 1.391, 95%CI = 1.193-1.623, P < 0.001) and OS (HR = 1.267, 95%CI = 1.080-1.486, P = 0.004). Notably, the combined AFP-FIB-4 score served as a stronger independent prognostic factor for both DFS (HR = 1.404, 95% CI = 1.204-1.638, P < 0.001) and OS (HR = 1.378, 95%CI = 1.196-1.588, P < 0.001). Subgroup analysis revealed that the FIB-4 index alone failed to significantly predict prognosis in patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C (P > 0.05), while AFP was ineffective in distinguishing prognosis in patients with BCLC stage 0 or A (P > 0.05). However, the AFP-FIB-4 score successfully stratified each BCLC stage subgroup into two groups with significantly different prognoses (all P < 0.05). ROC analysis demonstrated that the AFP-FIB-4 score achieved a significantly higher area under the curve (AUC 0.623) compared with AFP (AUC 0.553) and the FIB-4 index (AUC 0.565).

CONCLUSION

Incorporating AFP into the FIB-4 index enhances its prognostic performance. The AFP-FIB-4 score serves as a robust predictor of DFS and OS in HCC patients undergoing hepatectomy across different BCLC stages.