J Liver Cancer.  2019 Mar;19(1):12-18. 10.17998/jlc.19.1.12.

Clinical application of liver stiffness measurement for assessing the risk of hepatocellular carcinoma

• Yoo JJ
• Jung EA
• Kim SG

• KMID: 2448272
• DOI: http://doi.org/10.17998/jlc.19.1.12

Abstract

The most significant risk factor for hepatocellular carcinoma (HCC) is the presence of cirrhosis or advanced fibrosis of the liver. Liver biopsy was traditionally considered the gold standard for assessing the liver fibrosis burden. Recently, non-invasive methods, particularly transient elastography (TE), have proven effective at measuring fibrosis and determining cirrhosis. Clinical application of TE ranges from measuring fibrosis to predicting long-term prognosis and treatment response. Here, we focus on recent studies on the prognostic value of TE for predicting HCC.

Keyword

Hepatocellular carcinoma; Transient elastography; Liver stiffness; Liver fibrosis; Liver cirrhosis

MeSH Terms

Biopsy
Carcinoma, Hepatocellular*
Elasticity Imaging Techniques
Fibrosis
Liver Cirrhosis
Liver*
Prognosis
Risk Factors

Reference

1. Bolondi L, Sofia S, Siringo S, Gaiani S, Casali A, Zironi G, et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut. 2001; 48:251–259.

2. Lo RC, Kim H. Histopathological evaluation of liver fibrosis and cirrhosis regression. Clin Mol Hepatol. 2017; 23:302–307.

3. Wong GL. Prediction of fibrosis progression in chronic viral hepatitis. Clin Mol Hepatol. 2014; 20:228–236.

4. Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, et al. Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013; 11:1573–1584. e1-2;quiz e88-e89.

5. Kudo M. Prediction of hepatocellular carcinoma incidence risk by ultrasound elastography. Liver Cancer. 2014; 3:1–5.

6. Venkatesh SK, Yin M, Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Reson Imaging. 2013; 37:544–555.

7. Masuzaki R, Tateishi R, Yoshida H, Goto E, Sato T, Ohki T, et al. Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography. Hepatology. 2009; 49:1954–1961.

8. Narita Y, Genda T, Tsuzura H, Sato S, Kanemitsu Y, Ishikawa S, et al. Prediction of liver stiffness hepatocellular carcinoma in chronic hepatitis C patients on interferon- based anti-viral therapy. J Gastroenterol Hepatol. 2014; 29:137–143.

9. Tachi Y, Hirai T, Kojima Y, Ishizu Y, Honda T, Kuzuya T, et al. Liver stiffness measurement predicts hepatocellular carcinoma development in patients treated with direct-acting antivirals. JGH Open. 2017; 1:44–49.

10. Ravaioli F, Conti F, Brillanti S, Andreone P, Mazzella G, Buonfiglioli F, et al. Hepatocellular carcinoma risk assessment by the measurement of liver stiffness variations in HCV cirrhotics treated with direct acting antivirals. Dig Liver Dis. 2018; 50:573–579.

11. Jung KS, Kim SU, Ahn SH, Park YN, Kim DY, Park JY, et al. Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using liver stiffness measurement (FibroScan). Hepatology. 2011; 53:885–894.

12. Wong GL, Chan HL, Wong CK, Leung C, Chan CY, Ho PP, et al. Liver stiffness- based optimization of hepatocellular carcinoma risk score in patients with chronic hepatitis B. J Hepatol. 2014; 60:339–345.

13. Kim MN, Kim SU, Kim BK, Park JY, Kim DY, Ahn SH, et al. Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with transient elastography- defined subclinical cirrhosis. Hepatology. 2015; 61:1851–1859.

14. Jeon MY, Lee HW, Kim SU, Heo JY, Han S, Kim BK, et al. Subcirrhotic liver stiffness by FibroScan correlates with lower risk of hepatocellular carcinoma in patients with HBV-related cirrhosis. Hepatol Int. 2017; 11:268–276.

15. Shin SH, Kim SU, Park JY, Kim DY, Ahn SH, Han KH, et al. Liver stiffness-based model for prediction of hepatocellular carcinoma in chronic hepatitis B virus infection: comparison with histological fibrosis. Liver Int. 2015; 35:1054–1062.

16. Seo YS, Kim MN, Kim SU, Kim SG, Um SH, Han KH, et al. Risk assessment of hepatocellular carcinoma using transient elastography vs. liver biopsy in chronic hepatitis B patients receiving antiviral therapy. Medicine (Baltimore). 2016; 95:e2985.

17. Kim BS, Seo YS, Kim YS, Lee CH, Lee HA, Um SH, et al. Reduced risk of hepatocellular carcinoma by achieving a subcirrhotic liver stiffness through antiviral agents in hepatitis B virus-related advanced fibrosis or cirrhosis. J Gastroenterol Hepatol. 2018; 33:503–510.

18. Song BG, Sinn DH, Chi S, Kim K, Kang W, Gwak GY, et al. Additional role of liver stiffness measurement in stratifying residual hepatocellular carcinoma risk predicted by serum biomarkers in chronic hepatitis B patients under antiviral therapy. Eur J Gastroenterol Hepatol. 2018; 30:1447–1452.

19. Tatsumi A, Maekawa S, Sato M, Komatsu N, Miura M, Amemiya F, et al. Liver stiffness measurement for risk assessment of hepatocellular carcinoma. Hepatol Res. 2015; 45:523–532.

20. Adler M, Larocca L, Trovato FM, Marcinkowski H, Pasha Y, Taylor-Robinson SD. Evaluating the risk of hepatocellular carcinoma in patients with prominently elevated liver stiffness measurements by FibroScan: a multicentre study. HPB (Oxford). 2016; 18:678–683.

21. Sugihara T, Koda M, Matono T, Okamoto K, Murawaki Y, Isomoto H, et al. Risk assessment of hepatocellular carcinoma in general population by liver stiffness in combination with controlled attenuation parameter using transient elastography: a cross sectional study. Yonago Acta Med. 2017; 60:106–112.

22. Jung KS, Kim JH, Kim SU, Song K, Kim BK, Park JY, et al. Liver stiffness value- based risk estimation of late recurrence after curative resection of hepatocellular carcinoma: development and validation of a predictive model. PLoS One. 2014; 9:e99167.

23. Lee SH, Kim SU, Jang JW, Bae SH, Lee S, Kim BK, et al. Use of transient elastography to predict de novo recurrence after radiofrequency ablation for hepatocellular carcinoma. Onco Targets Ther. 2015; 8:347–356.

24. Lee YR, Park SY, Kim SU, Jang SY, Tak WY, Kweon YO, et al. Using transient elastography to predict hepatocellular carcinoma recurrence after radiofrequency ablation. J Gastroenterol Hepatol. 2017; 32:1079–1086.

25. Trotter JF. Elastography and the risk of hepatocellular carcinoma. Gastroenterol Hepatol (NY). 2018; 14:108–110.

26. Gomaa AI, Khan SA, Toledano MB, Waked I, Taylor-Robinson SD. Hepatocellular carcinoma: epidemiology, risk factors and pathogenesis. World J Gastroenterol. 2008; 14:4300–4308.

27. Yoshioka K, Kawabe N, Hashimoto S. Transient elastography: applications and limitations. Hepatol Res. 2008; 38:1063–1068.

28. Li JW, Ling WW, Lu Q, Lu CL, He D, Luo Y. Liver stiffness and serum alpha- fetoprotein in discriminating small hepatocellular carcinoma from cirrhotic nodule. Ultrasound Q. 2016; 32:319–326.

29. Liu XY, Ma LN, Yan TT, Lu ZH, Tang YY, Luo X, et al. Combined detection of liver stiffness and C-reactive protein in patients with hepatitis B virus-related liver cirrhosis, with and without hepatocellular carcinoma. Mol Clin Oncol. 2016; 4:587–590.

30. Kim SU, Kim BK, Park JY, Kim do Y, Ahn SH, Song K, et al. Transient elastography is superior to FIB-4 in assessing the risk of hepatocellular carcinoma in patients with chronic hepatitis B. Medicine (Baltimore). 2016; 95:e3434.