title: Liver stiffness-based model for prediction of hepatocellular carcinoma in chronic hepatitis B virus infection: comparison with histological fibrosis.
abstract: OBJECTIVE
  Liver stiffness (LS) value using transient elastography is a reliable, non-invasive tool for assessing liver fibrosis. LS-based prediction model, LSPS (=LS value × spleen diameter/platelet count) is well correlated with the risk of developing portal hypertension-related cirrhotic complications. Here, we assessed the prognostic performance of LSPS in predicting the development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).
  
  
  METHODS
  Between 2006 and 2010, we recruited 227 patients with CHB who underwent liver biopsy and LS measurement. The major end point was HCC development.
  
  
  RESULTS
  Median age was 45 years and 156 (68.7%) patients were male. During the follow-up period (median, 61 months), HCC developed in 18 patients. Patient with HCC had a higher LS value, a longer spleen, and lower platelet counts (all P < 0.05) than those without HCC. On multivariate analysis, LSPS was identified as an independent predictor of HCC development [hazard ratio (HR) 1.541, P < 0.001] after adjusting for age, serum albumin level and histological fibrosis stage. When patients were stratified into three groups (LSPS <1.1, 1.1-2.5 and >2.5), the 5-year cumulative risk of HCC increased significantly in association with a higher LSPS value (4.0, 13.8, 36.2%, respectively, P < 0.001). Patients with LSPS 1.1-2.5 (HR 2.0, P = 0.032) and LSPS > 2.5 (HR 8.7, P = 0.002) had a higher risk of developing HCC than those with LSPS < 1.1.
  
  
  CONCLUSIONS
  LS value-spleen diameter to platelet ratio score is useful for assessing the risk of HCC development and careful surveillance strategies are required in an individual manner.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Shin
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D018570:Risk Assessment; D013154:Spleen / Q000473:pathology
chemical_list: D000998:Antiviral Agents
keywords: chronic hepatitis B; fibroscan; hepatitis B virus; hepatocellular carcinoma; liver stiffness; platelet count; prediction; prognosis; spleen size