title: Risk Assessment of Hepatocellular Carcinoma Using Transient Elastography Vs. Liver Biopsy in Chronic Hepatitis B Patients Receiving Antiviral Therapy.
abstract: Liver stiffness (LS) assessed using transient elastography (TE) can assess the risk of developing hepatocellular carcinoma (HCC). We evaluated whether TE, when compared with histological data as a reference standard, can predict the risk of HCC development in chronic hepatitis B (CHB) patients starting antiviral therapy.Observational cohort database of 381 patients with CHB who underwent liver biopsy (LB) and TE were reviewed. All patients underwent surveillance for HCC development using ultrasonography and alpha-fetoprotein.During the median follow-up period of 48.1 (interquartile range 30.3-69.3) months, HCC developed in 34 (8.9%) patients. In patients with HCC development, age, proportion of diabetes mellitus, histological fibrosis stage, and LS value were significantly higher than those in patients without (all P <0.05). The cumulative incidence rates of HCC increased significantly in association with elevated LS value in 3 stratified groups (LS value <8, 8-13, and >13 kPa; log-rank test, P <0.001), and with higher histological fibrosis stage in 3 stratified groups (F0-2, F3, and F4; log-rank test, P <0.001). On multivariate analysis, along with age, LS value was an independent predictor of HCC development (hazard ratio 1.041, P <0.001), whereas histological staging was not (P >0.05).TE predicted HCC development independently in patients with CHB starting antiviral therapy. However, further investigation is needed to determine whether the current surveillance strategy can be optimized based on the LS value at the time of starting antiviral therapy.
authors.affiliation: From the Division of Gastroenterology and Hepatology (YSS, SHU), Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul; Department of Internal Medicine (MNK), CHA Bundang Medical Center, CHA University, Seongnam; Department of Internal Medicine (SUK, KHH), Institute of Gastroenterology, Yonsei University College of Medicine, Seoul; Department of Internal Medicine (SGK, YSK), Soonchunhyang University Bucheon Hospital, Bucheon; and Liver Cirrhosis Clinical Research Center (YSS, MNK, SUK, SGK, SHU, KHH, YSK), Seoul, Korea; The Korean Transient Elastography Study Group.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Mi Na
authors.initials: MN
authors.lastname: Kim
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Sang Gyune
authors.initials: SG
authors.lastname: Kim
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology*; D055088:Early Detection of Cancer; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers
chemical_list: D000998:Antiviral Agents