Liver stiffness measured by acoustic radiation force impulse elastography predicted prognoses of hepatocellular carcinoma after radiofrequency ablation

Abstract

The prognostic factors of patients who undergo radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is not fully elucidated. We aimed to investigate the role of liver stiffness (LS) and spleen stiffness (SS) measured by acoustic radiation force impulse (ARFI) elastography in determining the prognoses of patients with HCC after RFA. We prospectively enrolled 173 patients with HCC who underwent ARFI elastography for measurement of LS and SS on the same day of RFA. Overall survival (OS), recurrence-free survival (RFS) after adjusting for competing mortality, and presence of hepatic decompensation were investigated. Patients with LS > 1.5 m/s had significantly shorter OS and RFS than their counterparts. Anti-viral treatment (hazard ratio [HR]: 0.396, p = 0.015) and LS > 1.5 m/s (HR 4.105, p = 0.028) correlated with OS by a multivariate analysis. Besides, serum alpha fetoprotein >10 ng/mL and LS > 1.5 m/s independently predicted poorer RFS. On the other hand, anti-viral treatment (HR: 0.315, p = 0.010), creatinine > 1.5 mg/dL (HR: 9.447, p = 0.006), and SS > 2.7 m/s (HR: 2.869, p = 0.044) predicted a higher risk of hepatic decompensation. In conclusion, LS but not SS measured by ARFI elastography predicted tumor recurrence and OS in RFA-treated HCC; whereas, SS predicted development of hepatic decompensation in these patients. Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and contributes to enormous cancer-related deaths annually 1. Thanks to the well-developed principles of surveillance for HCC in high-risk patients, a large number of patients are diagnosed in the early stage and can be treated by loco-regional ablative therapies, such as radiofrequency ablation (RFA) 2,3. Nevertheless, the recurrence rates of HCC after RFA are significantly higher than those of surgical resection, in spite of the comparable survival benefit and less serious adverse effects 4-6. This affects the long-term prognosis of these patients 7. Besides tumor characteristics, field factors such as the stage of liver fibrosis and the degree of portal hypertension are important risk factors for developing HCC recurrence after treatment 8-10. Acoustic radiation force impulse (ARFI) elastography is a reliable tool for assessing the degree of liver stiffness (LS) and predicting the complications of patients with liver cirrhosis 11 .

Prognostic value of liver stiffness measurement in patients with hepatocellular carcinoma (HCC) treated by radiofrequency ablation: a meta-analysis

“…Of these, 576 were excluded by screening titles and abstracts (because they were either conference abstracts, letters, reviews, case reports or irrelevant studies), leaving 26 potentially relevant full-text articles. Eventually, eight studies [11][12][13][14][15][16][17][18] with a total of 1276 patients, were included in this meta-analysis. One of the included studies (Yoon et al [18]) compared the predictive value LSM evaluated by ARFI elastography versus TE; we treated this article as two separate studies -'Yoon 2018 AFFI' and 'Yoon 2018 TE'.…”

“…Of the eight studies, five were prospective and three were retrospective observational studies. All eight studies used ultrasound-based techniques for measurement of liver stiffness: five studies [11,[14][15][16]18] used TE, two studies [12,17] used SWE and two studies [13,18] used ARFI. No studies that used MRE for measurement of liver stiffness and examined its association with prognosis had been reported until the day of our literature search.…”

“…HBV was the most common cause of HCC in our studies, which is to be expected, given that chronic HBV infection is a leading cause of HCC in Eastern Asian countries. While three studies [11,15,16] fitted LSM as a continuous variable in a multivariable model, the other five [12][13][14]17,18] treated LSM as a categorical variable, using cutoff values identified by receiver operating characteristic curve analysis. All eight studies in this meta-analysis were identified as being of moderate quality with scores in the range of 5-6.…”

“…Among the five studies [12][13][14]17,18] that treated LSM as a categorical variable, four [12][13][14]17] examined the association between baseline LSM and OS. Pooled analysis of data from the four studies showed that high baseline LSM was significantly associated with poor OS (HR ¼ 4.31, 95% CI: 2.27-8.20, p < .001), with no heterogeneity (I 2 ¼ 0.0%; Figure 2).…”

“…One meta-analysis that included 1942 patients who underwent hepatic resection found that the LSM value was associated with liver-related postoperative complications, such as posthepatectomy liver failure, hepatic insufficiency and ascites [10]. Several studies have indicated that the LSM value can predict overall survival (OS) or recurrence in patients with HCC after ablation [11][12][13]; however, the results of these studies have not always been consistent.…”