Liver Stiffness Measured by Two-Dimensional Shear-Wave Elastography: Prognostic Value after Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

Purpose: To evaluate the prognostic value of liver stiffness (LS) measured using two-dimensional (2D) shear-wave elastography (SWE) in patients with hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA). Methods: The Institutional Review Board approved this retrospective study and informed consent was obtained from all patients. A total of 134 patients with up to 3 HCCs ≤5 cm who had undergone pre-procedural 2D-SWE prior to RFA treatment between January 2012 and December 2013 were enrolled. LS values were measured using real-time 2D-SWE before RFA on the procedural day. After a mean follow-up of 33.8 ± 9.9 months, we analyzed the overall survival after RFA using the Kaplan-Meier method and Cox proportional hazard regression model. The optimal cutoff LS value to predict overall survival was determined using the minimal p value approach. Results: During the follow-up period, 22 patients died, and the estimated 1- and 3-year overall survival rates were 96.4 and 85.8%, respectively. LS measured by 2D-SWE was found to be a significant predictive factor for overall survival after RFA of HCCs, as was the presence of extrahepatic metastases. As for the optimal cutoff LS value for the prediction of overall survival, it was determined to be 13.3 kPa. In our study, 71 patients had LS values ≥13.3 kPa, and the estimated 3-year overall survival was 76.8% compared to 96.3% in 63 patients with LS values <13.3 kPa. This difference was statistically significant (hazard ratio = 4.30 [1.26-14.7]; p = 0.020). Conclusion: LS values measured by 2D-SWE was a significant predictive factor for overall survival after RFA for HCC.

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

“…During the long-term follow-up after RFA for HCC, significantly negative effects on OS were found for age, prothrombin activity, advanced CTP grade, tumor size, tumor number, serum level of AFP, and the presence of porto-systemic collateral vessels 23,24,[31][32][33] . LS measured by two-dimensional shear-wave elastography has been reported as a significant predictive factor for OS after RFA for HCC 29 . However, in other studies in Korea, LS measured by TE or ARFI elastography did not have effective prediction performance for OS in HCC patients who received RFA 12,18 .…”

“…www.nature.com/scientificreports www.nature.com/scientificreports/ (including tumor size, number, tumor cell differentiation, vascular invasion, extra-hepatic metastasis, and serum AFP level), liver functional reserve (such as serum albumin level, platelet count, and portal hypertension), and field factors in the background liver (including the grade of hepatic inflammation and steatosis and the stage of liver fibrosis) 12,18,[25][26][27][28][29] .…”

Role of two-dimensional shear wave elastography in chronic liver diseases: A narrative review

“…Patients with LS ≥ 10kPa by 2D-SWE had a 4-fold higher risk of developing HCC than those with LS < 10 kPa. Lee et al[ 75 ] investigated the role of SWE in the prognosis of HCC after radiofrequency ablation (RFA). In 134 patients who underwent RFA as a curative treatment for HCC, LS by 2D-SWE was a significant predictor of overall survival and recurrence-free survival, and the optimal cutoff value was 13.3 kPa[ 75 ].…”

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

“…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.…”