Su1031 High Liver Stiffness Measurement by Transient Elastography Predicts High Grade Post-Hepatectomy Liver Failure in Patients With Hepatocellular Carcinoma: A Prospective Cohort Study

Abstract Background: The identification and selection of patients at-risk for HCC is a recognized challenge in outpatient clinical practice. Limited data on risk factors and the impact of HCC on cirrhotic patients stratified by the elasticity imaging technique are still a potential promise. Aim: To evaluate the clinical contribution of liver stiffness measurement by transient elastography, as a risk factor for Hepatocellular Carcinoma (HCC) occurrence in a prospective cohort of (HCV) patients with cirrhosis. Method: A cohort of 99 consecutive HCV patients was included between 2011 and 2016 with baseline liver stiffness equal or above 12 kPa. We evaluated the patients with serum and mechanical liver tests. Kaplan-Meier method with the log-rank test and the use of Cox Univariate and multivariate analysis assessed the association between variables and clinical results. Results: The mean age was 57.8±10.6 years. In a follow-up over a mean of 3.3 years, 20 (20.2%) patients developed HCC, of which 65% were male and 40% had diabetes. The median time to diagnosis of HCC was 2.6 years. In univariate logistic regression analysis, variables associated with HCC occurrence were: lower platelet count (p=0.0446), higher serum alpha-fetoprotein (p=0.0041) and bilirubin (p=0.0008) values, higher MELD score (p=0.0068) and higher liver stiffness measurement (p=0.0354). High LSM evaluated by TE was independently associated with HCC development, and the best cut-off value for HCC risk was > 21.1kPa (HR: 4.7695; 95%CI: 1.0470-21.7274; p=0.0435). Conclusion: High value of liver stiffness relates substantially to the increased risk for HCC in selected patients with HCV cirrhosis.

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Good performance of liver stiffness measurement in the prediction of postoperative hepatic decompensation in patients with cirrhosis complicated with hepatocellular carcinoma

Medical Ultrasonography ◽

10.11152/mu-1548 ◽

2018 ◽

Vol 20 (3) ◽

pp. 272 ◽

Cited By ~ 1

Author(s):

Bogdan Procopet ◽

Petra Fischer ◽

Adelina Horhat ◽

Emil Mois ◽

Horia Stefanescu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Liver Failure ◽

Venous Pressure ◽

Liver Stiffness ◽

Liver Stiffness Measurement ◽

End Points ◽

Stiffness Measurement ◽

Posthepatectomy Liver Failure ◽

Early Hcc

The evaluation of patients with early hepatocellular carcinoma (HCC) referred for liver resection is still a matter of debate. Aims: 1) to compare liver stiffness measurement (LSM) by transient elastography with hepatic venous pressure gradient (HVPG) in the prediction of decompensation after liver resection in patients with cirrhosis and early HCC; 2) to identify which definition for posthepatectomy liver failure is better associated with survival.Material and methods: Fifty-one patients (MELD score of 10±3) were included. In this group, 34 patients underwent HVPG measurement, of which 13 (38%) had clinically significant portal hypertension (CSPH) and 35 patients underwent LSM (21.8±17.9 kPa). The study’s end-points were: posthepatectomy liver failure (PHLF) defined according to International Study Group of Liver Surgery criteria and 3-month decompensation defined as de novo ascites, variceal bleeding, jaundice, hepatic encephalopathy and acute kidney injury. The performance of LSM compared to HVPG in predicting the end-points were assessed by AUROC curves and accuracy.Results: Twenty (39%) patients developed PHLF and 15 (29%) developed decompensationat 3 months. Three-month decompensation tended to be better correlated with survival. LSM performed well in predicting decompensation at 3 months (AUROC=0.78, 95%CI: 0.63-0.94; p=0.01), comparable with HVPG (AUROC=0.89, 95%CI: 0.79-1.00; p<0.01) (DeLong test p=0.21). LSM was not sufficiently accurate to predict PHLF.Conclusion: LSM has a similar performance to HVPG in predicting decompensation at 3 months in patients with early HCC submitted to liver resection. Three-month decompensation is better associated with survival.

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