Role of factor VIII in the prognosis and survival of patients with hepatocellular carcinoma

Objectives Factor VIII (FVIII) has been associated with disease progression and survival in patients with hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic value of FVIII levels in patients with HCC. Methods A total of 193 newly diagnosed patients with HCC were enrolled in a prospective cohort study. FVIII levels were measured before treatment. Patients subsequently received treatment and were followed up to assess overall survival (OS). Receiver operating characteristic curve (ROC) analysis to find an FVIII level discriminated between survival and mortality. Multivariate analysis was performed to determine whether the found value was truly an independent prognostic factor for HCC. Results The mean FVIII level was increased (211.7 %), with values ranging from 57.2 % to 499.1 %, and patients with increased FVIII levels constituted the majority of the study population (76.7 %). ROC analysis demonstrated that an FVIII level of 188.8 % effectively discriminated between survival and mortality outcomes. Regression analysis showed that patients with FVIII levels≥188.8 % had a 5.382-, 2.788-, 2.769-, and 3.126-fold higher risk of portal vein thrombosis, alpha-fetoprotein (AFP) ≥ 400 ng/mL, higher albumin–bilirubin (ALBI) grade, and Barcelona Clinic Liver Cancer (BCLC) stage B/C/D, respectively, compared with patients with lower FVIII levels. Kaplan–Meier analysis demonstrated that patients with FVIII levels ≥188.8 % had significantly shorter OS than those with FVIII levels <188.8 % (8.3 vs. 13.1 months, p<0.001). Multivariate Cox regression analysis, adjusted for the presence of metastasis, Child-Pugh grade, BCLC stage, and use of specific treatment, showed that patients with FVIII levels ≥188.8 % had nearly twice the risk of death compared with patients with lower FVIII levels. Conclusions Increased FVIII levels may be considered a poor prognostic factor in patients with HCC.