Comparison of serum WFA⁺‐M2BP, FIB‐4, and APRI for cirrhosis and esophageal varices prediction in hepatoma patients

Wisteria floribunda agglutinin‐positive Mac‐2 binding protein (WFA + ‐M2BP) is a novel biomarker for evaluating hepatic fibrosis and hepatocellular carcinoma (HCC) development. However, no previous study has compared its diagnostic accuracy with that of FIB‐4 or APRI nor explored its clinical application for predicting esophageal varices bleeding in HCC patients. In this study, we explored these biomarkers and compared their clinical roles. Total 459 HCC patients who underwent curative operation were enrolled in this study. WFA + ‐M2BP level was evaluated using stored blood samples that were collected during surgery, and liver fibrosis was diagnosed based on findings of surgical specimen analysis. Esophageal or gastric varices were evaluated in 207 patients who underwent esophagogastroduodenoscopy (EGD). The correlation between the markers was also determined. Our study showed WFA + ‐M2BP level, FIB‐4, and APRI had a similar high accuracy of approximately 73% for liver cirrhosis diagnosis. Their levels were significantly correlated with the liver fibrosis stage ( p < .0001). WFA + ‐M2BP level, FIB‐4, and APRI also had high diagnostic accuracy for varices formation (accuracy, 76.8%–80.2%) and high predictive accuracy for variceal bleeding (accuracy, 73.9%–76.3%). The correlation between WFA + ‐M2BP level and FIB‐4 or between WFA + ‐M2BP level and APRI was weak (Pearson r < 0.5, p < .0001) but that between FIB‐4 and APRI was very strong (Pearson r > 0.9, p < .0001). Our study demonstrated WFA + ‐M2BP level, FIB‐4, and APRI have all shown to be very useful noninvasive methods for evaluating liver fibrosis and predicting esophageal varices bleeding to avoid risky liver biopsy and EGD examination.