Akademik Veri Yönetim Sistemi
ANNALS OF CLINICAL AND ANALYTICAL MEDICINE, cilt.17, ss.167-171, 2026 (ESCI)
Aim: The FIB-4 index is a widely used noninvasive marker of hepatic fibrosis and has prognostic value in hepatocellular carcinoma (HCC). However, its association with tumor differentiation remains unclear. This study aimed to investigate the relationship between the fibrosis-4 (FIB-4) index and histological differentiation of HCC using 18F- fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) metabolic parameters. Methods: This retrospective, single-center study included 110 patients with newly diagnosed, histologically confirmed HCC who underwent 18F-FDG PET/CT between 2017 and 2024. Patients with moderately differentiated or unclassified tumors, prior liver-directed therapies, recurrent HCC, or other malignancies were excluded. Tumors were categorized as well-differentiated or poorly-differentiated. PET/CT-derived metabolic parameters were analyzed. The FIB-4 index was calculated at the time of imaging. Group comparisons, correlation analyses, and receiver operating characteristic (ROC) curve analyses were performed to evaluate associations among FIB-4, metabolic parameters, and tumor differentiation. Results: The median FIB-4 index did not differ significantly between well- and poorly differentiated HCC groups (4.2 vs. 4.5, p = 0.765). No significant correlation was observed between the FIB-4 index and PET metabolic parameters (all p > 0.05). In contrast, poorly-differentiated HCCs showed significantly higher metabolic activity, with markedly elevated SUVmax, SUVmean, SUVpeak, tumor-to-liver and tumor-to-blood ratios (all p < 0.001). ROC analysis showed that SUVmax had the highest diagnostic performance for predicting poor differentiation (AUC = 0.981), whereas the FIB-4 index had poor discriminative ability (AUC = 0.517). Conclusion: The FIB-4 index does not reflect histological differentiation in HCC and has limited utility for tumor grading. 18F-FDG PET/CT metabolic parameters provide superior discrimination of tumor differentiation, although overlap between grades underscores the need for a multimodal diagnostic approach.