title: Prognostic significance of liver stiffness for hepatocellular carcinoma and mortality in HBeAg-negative chronic hepatitis B.
abstract: The prognostic value of liver stiffness measurements for chronic hepatitis B (CHB) is not known. The present study aimed to investigate the use of transient elastography in predicting hepatocellular carcinoma (HCC) development and mortality in patients with CHB. Five hundred and twenty-eight patients with HBeAg-negative CHB underwent liver stiffness measurements and were prospectively followed up every 3-6 months for a median length of 35 months. The patients were divided into those with liver stiffness < 10 kPa (group 1) and ≥ 10 kPa (group 2). Of the 528 patients, 324 (61%) were men. The median age was 42 years. Compared with group 1, group 2 had a higher percentage of men, with higher median levels of age, liver biochemistry, and viral load. At the third year of follow-up, the cumulative incidence of HCC was higher in group 2 compared with group 1 (9%vs 0%, respectively, P < 0.001). The cumulative liver-related mortality was also higher in group 2 compared to group 1 (4%vs 0%, respectively, P < 0.001). After multivariate analysis, only liver stiffness measurement (LSM) was significantly associated with HCC development and mortality. There was also a higher cumulative incidence of hepatitis flares in group 2 compared to group 1 (46%vs 14%, respectively, P = 0.001) in patients with normal ALT, with higher LSM and AST being significantly associated with subsequent flares. In HBeAg-negative CHB patients, a liver stiffness measurement of ≥ 10 kPa was associated with a significantly increased risk of subsequent HCC development and mortality.
authors.affiliation: Department of Medicine, The University of Hong Kong, Pokfulam Road Queen Mary Hospital, Hong Kong SAR. mfyuen@hkucc.hku.hk
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: C-L
authors.initials: CL
authors.lastname: Lai
authors.forename: W-K
authors.initials: WK
authors.lastname: Seto
authors.forename: D K-H
authors.initials: DK
authors.lastname: Wong
authors.forename: M-F
authors.initials: MF
authors.lastname: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D006513:Hepatitis B e Antigens