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Hepatology International

, Volume 11, Issue 3, pp 268–276 | Cite as

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

  • Mi Young Jeon
  • Hye Won Lee
  • Seung Up KimEmail author
  • Ja Yoon Heo
  • Sojung Han
  • Beom Kyung Kim
  • Jun Yong Park
  • Do Young Kim
  • Sang Hoon Ahn
  • Kwang-Hyub Han
Original Article

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.

Keywords

Chronic hepatitis B Hepatocellular carcinoma Liver cirrhosis Liver stiffness Transient elastography 

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

Notes

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.

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.

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.

Supplementary material

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Supplementary material 1 (DOCX 38 kb)
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Supplementary material 2 (TIFF 349 kb)
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Supplementary material 3 (TIFF 783 kb)
12072_2017_9789_MOESM4_ESM.tif (344 kb)
Supplementary material 4 (TIFF 343 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2017

Authors and Affiliations

  • Mi Young Jeon
    • 1
  • Hye Won Lee
    • 1
  • Seung Up Kim
    • 1
    • 2
    • 3
    Email author
  • Ja Yoon Heo
    • 1
  • Sojung Han
    • 1
  • Beom Kyung Kim
    • 1
    • 2
    • 3
  • Jun Yong Park
    • 1
    • 2
    • 3
  • Do Young Kim
    • 1
    • 2
    • 3
  • Sang Hoon Ahn
    • 1
    • 2
    • 3
  • Kwang-Hyub Han
    • 1
    • 2
    • 3
  1. 1.Department of Internal MedicineYonsei University College of MedicineSeoulKorea
  2. 2.Institute of GastroenterologyYonsei University College of MedicineSeoulKorea
  3. 3.Liver Cirrhosis Clinical Research CenterSeoulKorea

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