Liver stiffness measurement in the risk assessment of hepatocellular carcinoma for patients with chronic hepatitis

Abstract

Backgroud/aims The risk of hepatocellular carcinoma (HCC) increased with progression of hepatic fibrosis as assessed by liver stiffness measurement (LSM). This study used LSM to assess the risk of HCC presence in patients with chronic hepatitis. Methods The patients with liver tumor or chronic hepatitis indicated for biopsy were prospectively enrolled. LSM was performed on the same day as biopsy. The diagnostic performances of clinical parameters and LSM in predicting HCC presence were compared with the areas under receiver operating characteristics curves (AUROC). The risk of HCC presence was assessed with stratum-specific likelihood ratios (SSLR). The cut-off values and its diagnostic validity were calculated for LSM. Results A total of 435 patients, including 106 HCC and 329 chronic hepatitis, were enrolled. The AUROC in predicting HCC presence was 0.736, 0.733, 0.594, 0.579 and 0.532 for LSM, alpha-fetoprotein, platelet count, total bilirubin, and aspartate aminotransferase-platelet ratio index, respectively. Multivariate analysis showed liver stiffness was an independent factor for HCC presence (odds ratio 1.07, 95% confidence interval (CI) 1.05-1.09). SSLR for HCC presence by liver stiffness was 0.43 (95% CI 0.32-0.57) in\12 kPa, in [24 kPa. With 12 and 24 kPa as the cut-offs in predicting HCC presence, the sensitivity was 69.8 and 41.5%, respectively. The specificity was 69.6 and 92.7%, respectively. Conclusions LSM identified the risk group for HCC presence in chronic hepatitis patients and had high specificity in the prediction of HCC with the cut-off of 24 kPa.

Liver stiffness measured by transient elastography is a predictor of hepatocellular carcinoma development in viral hepatitis

“…The relationship between presence or absence of HCC and liver stiffness was investigated by Masuzaki et al 9 . in a group of hepatitis C patients, by Kuo et al 13 . in a group of hepatitis B and hepatitis C patients, and by Nahon et al 11 .…”

“…Measurement of liver stiffness by transient elastography is a rapid, noninvasive, and reproducible method that reportedly offers an accurate representation of the extent of hepatic fibrosis in viral hepatitis and non‐alcoholic steatohepatitis 1–8 . However, few reports have examined the relationship between liver stiffness measurements by transient elastography and hepatocellular carcinoma (HCC) 9–13 . This study investigated the value of liver stiffness in diagnosing HCC among patients with viral hepatitis, and prospectively investigated the relationship between liver stiffness and HCC development.…”

Fibrosis evolution in chronic hepatitis B e antigen‐negative patients across a 10‐year interval

“…It appears that in this subgroup of patients, the absolute LS value at baseline or 10‐year follow‐up, rather than the magnitude of fibrosis regression, was more important with respect to risk of cirrhosis and HCC. LSM has been incorporated into HCC risk prediction models . However, whether these models can be applied in NA‐treated patients is still unknown.…”

Liver stiffness measurement using transient elastography and hepatocellular carcinoma

“…revealed that liver stiffness measurement using transient elastography was strongly associated with the probability of the presence of HCC among patients with hepatitis C in a cross‐section setting 30 . The usefulness of transient elastography for the estimation of predicting the risk of HCC development was also suggested in other cross‐sectional setting studies, intended for patients with hepatitis B and C, and for patients with hepatitis C and alcoholic liver disease 10,31 . On the other hand, prospective cohort studies published previously, with respect to the association between liver stiffness measured by transient elastography and the risk of HCC development, consist of only two papers at present.…”