title: Evaluating the risk of hepatocellular carcinoma in patients with prominently elevated liver stiffness measurements by FibroScan: a multicentre study.
abstract: There are limited data on the significance of liver stiffness measurements (LSM) by transient elastography in the upper extreme end of the measurable spectrum. This multicentre retrospective observational study evaluated the risk of hepatocellular carcinoma (HCC) in patients with LSM ≥20 kPa.
  
  
  
  432 cirrhosis patients with LSM ≥20 kPa between June 2007 and October 2015 were retrospectively followed-up through electronic records.
  
  
  
  A minimum 1-year follow-up was available for 278 patients (177 men; average age 57, range 18-84). LSM ranged from 20.0 to 75.0 kPa (mean 34.6 kPa). Cumulative incidences of HCC were 19 (6.8%), 30 (10.8%) and 41 (14.7%) at 1, 2 and 3 years, respectively. HCC was associated with age (p = 0.003), higher LSM (p = 0.005) and viral aetiology (p = 0.007). Patients were divided into 4 groups based on LSM at entry: 20-25 kPa (n = 74); 25-30 kPa (n = 62); 30-40 kPa (n = 75); >40 kPa (n = 67). Compared to the 20-25 kPa group, the 30-40 kPa group had a hazard ratio (HR) of 3.0 (95% CI, 1.1-8.3; p = 0.037), and the >40 kPa group had a HR of 4.8 (95% CI, 1.7-13.4; p = 0.003).
  
  
  
  This study shows an association between LSM at the upper extreme and HCC risk. Physicians may find this beneficial as a non-invasive dynamic approach to assessing HCC risk in cirrhosis patients.
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK. Electronic address: maciej.adler11@imperial.ac.uk.
authors.forename: Maciej
authors.initials: M
authors.lastname: Adler
authors.affiliation: Infectious Disease Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
authors.forename: Licia
authors.initials: L
authors.lastname: Larocca
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Trovato
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Marcinkowski
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Pasha
authors.affiliation: Hepatology and Gastroenterology Section, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, St. Mary's Hospital Campus, Imperial College London, UK.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D016009:Chi-Square Distribution; D054459:Elasticity Imaging Techniques; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology*; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult