The Role of Liver Stiffness Measurement in Advanced Hepatocellular Carcinoma
The Role of LSM in Advanced HCC
Keywords:
Chronic hepatitis B, transient elastography, FibroScan, liver fibrosisAbstract
Introduction: Liver stiffness measurement (LSM) by transient elastography is associated with risks of HCC and post-surgical outcomes of patients undergoing hepatectomy. However, the role of LSM in patients with advanced HCC is less clear. Methods: Patients with a confirmed diagnosis of HCC were prospectively recruited from March 2013 to April 2019. Prior to commencing treatment for HCC, all patients underwent transient elastography (FibroScan®) by hepatologists. The LSM reading, baseline characteristics, and tumor information of patients were recorded. All patients were followed up prospectively for survival events. Results: A total of 165 patients with HCC were recruited. The median follow-up was 40.6 months. The median overall survival was 11.9 months. The median age was 62 years with 77% having chronic hepatitis B. Most patients (69.7%) underwent non-surgical treatment (including transarterial chemoembolization and systemic therapy) and supportive care (19.4%) whereas the remaining patients (10.9%) underwent surgery. The median LSM was 26.3kPa (Range = 3.5-75), where the closest integral of 30kPa was chosen as a cut-off for analyses. LSM was correlated with the diameter of the right lobe tumor (R = 0.463; p < 0.0001). It was also correlated with a more advanced BCLC stage (p = 0.0006) and worse ALBI grade (p = 0.0002). Patients with LSM > 30kPa had worse OS than patients with LSM ≤ 30kPa (Median OS = 5.4 months, 95% CI [2.7-8.1] [>30kPa] vs 21.2 months, 95% CI [17.6-24.7] [≤30kPa]; HR = 2.156; [95% Cl = 1.514-3.069]; p = 0.0001). In multivariable analysis, LSM > 30kPa remained an independent predictor of survival after adjustment with ALBI grade, ALP, and BCLC stage. Discussions: An LSM >30kPa is a significant and independent predictor of survival for HCC.
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Copyright (c) 2023 Ka H. Ngai, Grace L.H. Wong, Leung Li, Frankie Mo, Yat M. Lau, Kelvin K.C. Ng, Terry C.F. Yip, Vincent W.S. Wong, Henry L.Y. Chan, Stephen L. Chan
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