Liver stiffness measurements may ‘personalize’ HCC risk, surveillance needs in MASLD

Key takeaways:

• Hepatocellular carcinoma risk increased by 19% with every 5 kPa increase in liver stiffness measurement.
• Liver stiffness measurements may also be used to identify surveillance needs.

SAN DIEGO — Liver stiffness measurements may help predict the risk for hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease, as well as identify those in need of surveillance, according to data.

“MASLD is the commonest liver disease in the world and the fastest rising cause of liver cancer,” Binu John, MD, MPH, chief of gastroenterology and hepatology at Miami VA Health System and associate professor at University of Miami Miller School of Medicine, told Healio. “A third of HCC in MASLD occurs in the absence of cirrhosis.”

He continued, “We wanted to examine if we could identify a noninvasive way to predict risk of HCC in MASLD and to identify patients with MASLD without cirrhosis who may qualify for surveillance.”

Using the Veterans Analysis of Liver Disease study database, John and colleagues retrospectively reviewed data from 30,414 veterans with MASLD who underwent transient elastography between May 27, 2014, and Jan. 5, 2023, and were followed through June 2023 or until HCC or death.

The researchers used liver stiffness measurement (LSM) data, divided into training and testing datasets, to predict the risk for HCC.

According to results presented at The Liver Meeting, for every 5 kPa increase in liver stiffness, there was a 19% increase in the risk for HCC (adjusted HR = 1.19; 95% CI ,1.15-1.24), with the annual rate of HCC also increasing with LSM: 0.06% (LSM < 10 kPa), 0.41% (LSM 10-19.9 kPa), 0.99% (LSM 20-29.9 kPa) and 0.95% (LSM > 30 kPa).

Further, in patients without cirrhosis or portal hypertension, John noted the annual HCC risk was “above the threshold” recommended for cost-effective HCC surveillance (> 0.4% per 100 person-years) among men with diabetes and those with LSM of 10 kPa to 14.9 kPa.

“Liver stiffness measurement can be used to personalize liver cancer risk in patients with MASLD and potentially identify patients for surveillance,” John said. “Patients with MASLD routinely undergo liver stiffness measurements to identify if they qualify for treatment, need variceal surveillance and to estimate their risk of decompensation. The data suggest that the information using LSM can also help to predict risk of HCC and identify patients who need surveillance.”