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Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy

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ABSTRACT

Liver stiffness (LS) assessed using transient elastography (TE) can assess the risk of developing hepatocellular carcinoma (HCC). We evaluated whether TE, when compared with histological data as a reference standard, can predict the risk of HCC development in chronic hepatitis B (CHB) patients starting antiviral therapy.

Observational cohort database of 381 patients with CHB who underwent liver biopsy (LB) and TE were reviewed. All patients underwent surveillance for HCC development using ultrasonography and alpha-fetoprotein.

During the median follow-up period of 48.1 (interquartile range 30.3–69.3) months, HCC developed in 34 (8.9%) patients. In patients with HCC development, age, proportion of diabetes mellitus, histological fibrosis stage, and LS value were significantly higher than those in patients without (all P <0.05). The cumulative incidence rates of HCC increased significantly in association with elevated LS value in 3 stratified groups (LS value <8, 8–13, and >13 kPa; log-rank test, P <0.001), and with higher histological fibrosis stage in 3 stratified groups (F0–2, F3, and F4; log-rank test, P <0.001). On multivariate analysis, along with age, LS value was an independent predictor of HCC development (hazard ratio 1.041, P <0.001), whereas histological staging was not (P >0.05).

TE predicted HCC development independently in patients with CHB starting antiviral therapy. However, further investigation is needed to determine whether the current surveillance strategy can be optimized based on the LS value at the time of starting antiviral therapy.

No MeSH data available.


Related in: MedlinePlus

The cumulative incidence rates of HCC (A) and LRE (B) according to the changes in LS values (n = 134). The overall incidence rates of HCC and LRE differed significantly among the 3 groups (log-rank test, all P <0.001). HCC = hepatocellular carcinoma; LRE = liver-related event.
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Figure 3: The cumulative incidence rates of HCC (A) and LRE (B) according to the changes in LS values (n = 134). The overall incidence rates of HCC and LRE differed significantly among the 3 groups (log-rank test, all P <0.001). HCC = hepatocellular carcinoma; LRE = liver-related event.

Mentions: Of the study population, a second TE examination was available at the time of VR after a median of 13.2 (range, 6.0–24.0) months in 139 (36.5%) patients. We excluded 5 patients who showed an increase in LS value from <13 kPa at baseline to ≥13 kPa at follow-up to prevent statistical error caused by a small sample size. The remaining patients were divided into 3 groups (group 1: n = 75, LS value <13 kPa at baseline and follow-up; group 2: n = 33, LS value ≥13 kPa at baseline and <13 kPa at follow-up; group 3: n = 26, LS values >13 kPa both at baseline and follow-up). The cumulative incidence rates of HCC and LRE differed significantly among the 3 groups (log-rank test, all P <0.001) (Figure 3A and B).


Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy
The cumulative incidence rates of HCC (A) and LRE (B) according to the changes in LS values (n = 134). The overall incidence rates of HCC and LRE differed significantly among the 3 groups (log-rank test, all P <0.001). HCC = hepatocellular carcinoma; LRE = liver-related event.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998368&req=5

Figure 3: The cumulative incidence rates of HCC (A) and LRE (B) according to the changes in LS values (n = 134). The overall incidence rates of HCC and LRE differed significantly among the 3 groups (log-rank test, all P <0.001). HCC = hepatocellular carcinoma; LRE = liver-related event.
Mentions: Of the study population, a second TE examination was available at the time of VR after a median of 13.2 (range, 6.0–24.0) months in 139 (36.5%) patients. We excluded 5 patients who showed an increase in LS value from <13 kPa at baseline to ≥13 kPa at follow-up to prevent statistical error caused by a small sample size. The remaining patients were divided into 3 groups (group 1: n = 75, LS value <13 kPa at baseline and follow-up; group 2: n = 33, LS value ≥13 kPa at baseline and <13 kPa at follow-up; group 3: n = 26, LS values >13 kPa both at baseline and follow-up). The cumulative incidence rates of HCC and LRE differed significantly among the 3 groups (log-rank test, all P <0.001) (Figure 3A and B).

View Article: PubMed Central - PubMed

ABSTRACT

Liver stiffness (LS) assessed using transient elastography (TE) can assess the risk of developing hepatocellular carcinoma (HCC). We evaluated whether TE, when compared with histological data as a reference standard, can predict the risk of HCC development in chronic hepatitis B (CHB) patients starting antiviral therapy.

Observational cohort database of 381 patients with CHB who underwent liver biopsy (LB) and TE were reviewed. All patients underwent surveillance for HCC development using ultrasonography and alpha-fetoprotein.

During the median follow-up period of 48.1 (interquartile range 30.3&ndash;69.3) months, HCC developed in 34 (8.9%) patients. In patients with HCC development, age, proportion of diabetes mellitus, histological fibrosis stage, and LS value were significantly higher than those in patients without (all P&#8202;&lt;0.05). The cumulative incidence rates of HCC increased significantly in association with elevated LS value in 3 stratified groups (LS value &lt;8, 8&ndash;13, and &gt;13 kPa; log-rank test, P&#8202;&lt;0.001), and with higher histological fibrosis stage in 3 stratified groups (F0&ndash;2, F3, and F4; log-rank test, P&#8202;&lt;0.001). On multivariate analysis, along with age, LS value was an independent predictor of HCC development (hazard ratio 1.041, P&#8202;&lt;0.001), whereas histological staging was not (P&#8202;&gt;0.05).

TE predicted HCC development independently in patients with CHB starting antiviral therapy. However, further investigation is needed to determine whether the current surveillance strategy can be optimized based on the LS value at the time of starting antiviral therapy.

No MeSH data available.


Related in: MedlinePlus