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Subcirrhotic liver stiffness by FibroScan correlates with lower risk of hepatocellular carcinoma in patients with HBV-related cirrhosis

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Abstract

Background and Aims

The risk of developing hepatocellular carcinoma (HCC) varies, even in the context of cirrhosis. We investigated the relationship between liver stiffness (LS) in subcirrhotic range, assessed via transient elastography (TE), and risk of HCC development in patients with chronic hepatitis B (CHB)-related cirrhosis.

Methods

Data on 540 patients presenting with clinically evident CHB-related cirrhosis between April 2006 and December 2014 were reviewed retrospectively. Subcirrhotic range of LS was defined by TE values ≤13 kPa.

Results

Of the study population, 214 (39.6%) had LS values in the subcirrhotic range. During follow-up (median 54.1 months), 81 patients (15.0%) developed HCC. In conjunction with age, male gender, and diabetes mellitus, subcirrhotic LS value (hazard ratio = 0.462) was an independent predictor of HCC development on multivariate analysis (all p < 0.05). Cumulative HCC incidence was significantly lower for patients in subcirrhotic (versus cirrhotic) LS range (log-rank test, p < 0.05). In our cohort, the modified REACH-B score performed better than other prediction models, namely REACH-B, CU-HCC, and LSM-HCC scoring systems (area under receiver operating characteristic curve: 0.717 versus 0.669, 0.578, and 0.624, respectively, for 7-year HCC risk).

Conclusions

A significant association between subcirrhotic range of LS value and lower risk of HCC development was identified in patients with clinically evident CHB-related cirrhosis. Thus, different TE-based HCC surveillance strategies may be required even in patients with identical liver cirrhosis disease category.

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Abbreviations

CHB:

Chronic hepatitis B

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

LS:

Liver stiffness

TE:

Transient elastography

AFP:

Alpha-fetoprotein

kPa:

Kilopascals

cLS group:

Cirrhotic LS group

scLS group:

Subcirrhotic LS group

IQR:

Interquartile range

CU:

The Chinese University of Hong Kong

REACH-B:

Risk estimation for HCC in CHB

LSM:

Liver stiffness measurement

mREACH-B:

Modified risk estimation for HCC in CHB

ALT:

Alanine aminotransferase

HBeAg:

Hepatitis B e antigen

HR:

Hazard ratio

CI:

Confidence interval

AUROC:

Area under the receiver operating characteristic curve

SPSS:

Statistical Package for the Social Sciences

BMI:

Body mass index

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Acknowledgements

This study was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (2016R1A1A1A05005138) and by Research of Korea Centers for Disease Control and Prevention (HD15A0351). The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

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    Authors and Affiliations

    1. Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea

      Mi Young Jeon, Hye Won Lee, Seung Up Kim, Ja Yoon Heo, Sojung Han, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn & Kwang-Hyub Han

    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

      Seung Up Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn & Kwang-Hyub Han

    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea

      Seung Up Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn & Kwang-Hyub Han

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    1. Mi Young Jeon
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    2. Hye Won Lee
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    Correspondence to Seung Up Kim.

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    Conflict of interest

    Mi Young Jeon, Hye Won Lee, Seung Up Kim, Ja Yoon Heo, Sojung Han, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, and Kwang-Hyub Han have no conflicts of interest to declare.

    Ethical approval

    This study was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Institutional Review Board of Severance Hospital. Due to its retrospective nature, written informed consent was not required.

    Additional information

    M. Y. Jeon and H. W. Lee contributed equally to this work.

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    Jeon, M.Y., Lee, H.W., Kim, S.U. et al. Subcirrhotic liver stiffness by FibroScan correlates with lower risk of hepatocellular carcinoma in patients with HBV-related cirrhosis. Hepatol Int 11, 268–276 (2017). https://doi.org/10.1007/s12072-017-9789-y

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