Subcirrhotic liver stiffness by FibroScan correlates with lower risk of hepatocellular carcinoma in patients with HBV-related cirrhosis
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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.
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.
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).
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.
KeywordsChronic hepatitis B Hepatocellular carcinoma Liver cirrhosis Liver stiffness Transient elastography
Chronic hepatitis B
Hepatitis B virus
- cLS group
Cirrhotic LS group
- scLS group
Subcirrhotic LS group
The Chinese University of Hong Kong
Risk estimation for HCC in CHB
Liver stiffness measurement
Modified risk estimation for HCC in CHB
Hepatitis B e antigen
Area under the receiver operating characteristic curve
Statistical Package for the Social Sciences
Body mass index
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.
Compliance with ethical standards
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.
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.
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