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TE accurate in diagnosing subclinical cirrhosis in patients at risk for HBV-related HCC

Researchers in Korea used transient elastography and found it to be useful in identifying subclinical cirrhosis among patients at risk for hepatitis B virus infection-related hepatocellular carcinoma who did not have evidence of cirrhosis, according to study data.

“We showed that [transient elastography] can identify patients with [subclinical cirrhosis] who are at increased risk of developing [hepatocellular carcinoma] in [chronic hepatitis B] patients without clinical evidence of [liver stiffness],” the researchers wrote. “The concept of [transient elastography]-defined [subclinical cirrhosis] might help the physician to modify the management and surveillance strategies for [chronic hepatitis B] patients and also activate following studies in this field.”

Researchers, including Seung Up Kim, MD, PhD, and Kwang-Hyub Han, MD, department of internal medicine, Yonsei University College of Medicine, Seoul, Korea, analyzed data of 2,876 patients without clinical cirrhosis who underwent transient elastography (TE) examinations between April 2006 and December 2012. Subclinical cirrhosis (SCC) was defined as a non-clinical cirrhosis with a liver stiffness (LS) of at least 13 kPa.

Sixty-two percent of patients enrolled in the study were male. Of all the patients, the mean LS value was 7.9 kPa, and SCC was found in 9.9% of patients (n = 285).

The median follow-up period was 48.9 months and during this time, researchers found that the cumulative incidence rate of HCC in the SCC group was significantly higher than that in the non-SCC group (P < .001). The cumulative incidence rate was 1.3% at 3 years, 2.3% at 5 years and 5.2% at 7 years. Overall, 52 patients developed HCC, of which 16 patients had SCC and 36 patients did not have SCC.

The mean LS value of patients with SCC was 22.7 kPa and these patients had higher proportions of diabetes, hypertension, total bilirubin and alpha-fetoprotein compared with the non-SCC group. Patients without SCC had higher serum albumin and platelet count compared with the SCC patients (P < .001 for both).

Multivariate analysis showed SCC to be independently associated with a risk of developing HCC, regardless of antiviral therapy (without antiviral therapy: HR = 4.68; 95% CI, 1.187-18.441; P = .027 vs. with antiviral therapy: HR = 3.344; 95% CI, 1.526-7.328; P = .003).

“In the future, further studies are warranted to confirm that the incorporation of TE into the current surveillance strategy for HCC is beneficial and cost-effective,” the researchers concluded – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.