Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography.
Liver stiffness, noninvasively measured by transient elastography, correlates well with liver fibrosis stage. The aim of this prospective study was to evaluate the liver stiffness measurement (LSM) as a predictor of hepatocellular carcinoma (HCC) development among patients with chronic hepatitis C. Between December 2004 and June 2005, a total of 984 HCV-RNA positive patients, without HCC or a past history of it, visited the University of Tokyo Hospital. LSM was performed successfully in 866 patients, who gave informed consent. During the follow-up period (mean, 3.0 years), HCC developed in 77 patients (2.9% per 1 person-year). The cumulative incidence rates of HCC at 1, 2, and 3 years were 2.4%, 6.0%, and 8.9%, respectively. Adjusting for other significant factors for HCC development, patients with higher LSM were revealed to be at a significantly higher risk, with a hazard ratio, as compared to LSM < or =10 kPa, of 16.7 (95% confidence interval [CI], 3.71-75.2; P < 0.001) when LSM 10.1-15 kPa, 20.9 (95% CI, 4.43-98.8; P < 0.001) when LSM 15.1-20 kPa, 25.6 (95%CI, 5.21-126.1; P < 0.001) when LSM 20.1-25 kPa, and 45.5 (95% CI, 9.75-212.3; P < 0.001) when LSM >25 kPa.


CONCLUSIONS
This prospective study has shown the association between LSM and the risk of HCC development in patients with hepatitis C. The utility of LSM is not limited to a surrogate for liver biopsy but can be applied as an indicator of the wide range of the risk of HCC development.
Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
Ryota
R
Masuzaki
Ryosuke
R
Tateishi
Haruhiko
H
Yoshida
Eriko
E
Goto
Takahisa
T
Sato
Takamasa
T
Ohki
Jun
J
Imamura
Tadashi
T
Goto
Fumihiko
F
Kanai
Naoya
N
Kato
Hitoshi
H
Ikeda
Shuichiro
S
Shiina
Takao
T
Kawabe
Masao
M
Omata
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology*; D054459:Elasticity Imaging Techniques; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult