title: Liver stiffness measurement as an alternative to fibrotic stage in risk assessment of hepatocellular carcinoma incidence for chronic hepatitis C patients.
abstract: BACKGROUND
  Hepatic fibrosis stage is useful in assessing risk of hepatocellular carcinoma (HCC) occurrence.
  
  
  OBJECTIVE
  To evaluate liver stiffness measurement (LSM), in addition to fibrosis stage, in risk assessment of long-term HCC occurrence for patients with chronic hepatitis C.
  
  
  METHODS
  Consecutive patients with chronic hepatitis C, without past history and presence of HCC, with concomitant liver biopsy and LSM were enrolled in this study. All patients attended regular surveillance for HCC development every 3-12 months. The medical records were reviewed. Follow-up LSM was performed at least 1 year later.
  
  
  RESULTS
  One hundred and ninety-eight patients (M/F: 112/86) with reliable LSM results were enrolled. Ten patients developed HCC in a median follow-up period of 47.8 months. For patients with initial LSM >24 kPa, 12-24 kPa, and <12 kPa, 5- year HCC incidence was 45.1%, 9.5% and 0.9% respectively. Multivariate analysis showed patients with LSM>24 kPa and patients with LSM 12-24 kPa had higher risks of HCC development (HR: 24.6, CI: 2.7-220.4 and HR:11.7, CI:1.3-105.2). Patients without sustained virological response after treatment also had higher risk of HCC occurrence (HR: 9.7, CI: 1.1-82.2). Among 106 patients with follow-up LSM, there was a higher risk of HCC development for patients with LSM>12 kPa in the initial and follow-up LSM.
  
  
  CONCLUSIONS
  As an alternative of fibrosis stage, initial LSM is useful as a non-invasive method in risk assessment of HCC occurrence for patients with chronic hepatitis C. Serial follow-up LSM>12 kPa carries higher risk of HCC development.
authors: Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Hsin-Ming
authors: HM
authors: Wang
authors: Chao-Hung
authors: CH
authors: Hung
authors: Sheng-Nan
authors: SN
authors: Lu
authors: Chien-Hung
authors: CH
authors: Chen
authors: Chuan-Mo
authors: CM
authors: Lee
authors: Tsung-Hui
authors: TH
authors: Hu
authors: Jing-Houng
authors: JH
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D018709:Statistics, Nonparametric