title: Risk assessment of hepatocellular carcinoma in chronic hepatitis C patients by transient elastography.
abstract: OBJECTIVE
  The degree of liver fibrosis is the strongest indicator of risk for hepatocellular carcinoma (HCC) development. Recently developed transient elastography (Fibroscan, Echosens, France) noninvasively measures liver stiffness, and the correlation between the stiffness and liver fibrosis stage has been validated. In this cross-sectional study, we investigated the relationship between liver stiffness and HCC presence.
  
  
  METHODS
  Liver stiffness was measured in chronic hepatitis C patients (85 with HCC and 180 without) by transient elastography. Multivariate logistic regression was applied to assess the association with HCC presence. We computed the receiver operating characteristics (ROC) curves concerning the prediction of HCC presence and compared the areas under ROC curve (AUROC). We also calculated stratum-specific likelihood ratios (SSLR).
  
  
  RESULTS
  Multivariate analysis showed that HCC presence was significantly associated with liver stiffness (P<0.0001) along with age, male, and alpha-fetoprotein concentration. AUROC was 0.805, 0.741, 0.714, 0.673, 0.670, and 0.654 for liver stiffness, alpha-fetoprotein, albumin, prothrombin activity, AST-platelet ratio index, and platelet count, respectively. Other parameters showed smaller AUROC. SSLR for HCC presence by liver stiffness was 0.22 (95% confidence interval: 0.11-0.42) in <10 kPa, 0.73 (0.39 to 1.39) in 10.1 to 15 kPa, 1.30 (0.80 to 2.12) in 15.1 to 25 kPa, and 5.0 (2.96 to 8.47) in >25 kPa.
  
  
  CONCLUSIONS
  Liver stiffness measured by transient elastography is useful in demarcating chronic hepatitis C patients at a high risk for HCC, who require frequent check-up by imaging examinations.
authors.affiliation: Department of Gastroenterology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Masuzaki
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Hideo
authors.initials: H
authors.lastname: Yoshida
authors.forename: Shinpei
authors.initials: S
authors.lastname: Sato
authors.forename: Naoya
authors.initials: N
authors.lastname: Kato
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kanai
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Sugioka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003430:Cross-Sectional Studies; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D016013:Likelihood Functions; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment