Baseline FIB‐4 May Be a Risk Factor of Recurrence After SBRT in Patients With HBV‐Related Small HCC

ABSTRACT Aims Exploring fibrosis index‐4 (FIB‐4)'s predictive value for HBV‐related hepatocellular carcinoma (HCC) in assessing recurrence following stereotactic body radiation therapy (SBRT) in patients with HBV‐related HCC. Methods HBV‐related HCC patients who underwent SBRT were retrospectively enrolled from March 2012 to March 2020. Patients were divided into recurrence and non‐recurrence groups based on the HCC recurrence situation. Baseline data were collected from all patients before treatment and at 3 and 6 months after treatment, and FIB‐4 was calculated at the corresponding time points. Risk factors were selected using Cox regression. The FIB‐4 was stratified for survival analysis. Results One hundred and fifty‐two patients were included. With a mean age of 53.5 years old, 94.1% of them had liver cirrhosis. The median recurrence‐free survival (RFS) time for recurrent patients was 17.5 months. The tumor response rate of SBRT was 94.8%. HCC recurrence rates at 12, 24, 36, 48, and 60 months were 19.7% (30/152), 38.2% (58/152), 48.0% (73/152), 52.0% (79/152), and 53.3% (81/152), respectively. Cox regression showed that baseline FIB‐4 (95% CI: 1.030 ~ 1.144, p = 0.002) and 3 tumor nodules (95% CI: 3.727 ~ 260.663, p = 0.002) are risk factors for HCC recurrence. Patients with a baseline FIB‐4 > 6.55 were at a higher risk of HCC recurrence than those with a baseline FIB‐4 < 6.55 ( p < 0.001). Conclusion Baseline FIB‐4 is a risk factor for recurrence after SBRT in patients with HBV‐related HCC, and the predictive threshold for FIB‐4 is higher in patients with cirrhosis. For patients who received radiotherapy, postoperative FIB‐4 levels are elevated.