Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using liver stiffness measurement (FibroScan®)

Abstract

Background/ Aims: Liver stiffness measurement (LSM) using FibroScan® accurately assesses the degree of liver fibrosis and the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C (CHC). This study investigated the usefulness of LSM as a predictor of HCC development in patients with chronic hepatitis B (CHB).Methods: A total of 1,130 patients with non-biopsy proven CHB who underwent LSM between May 2005 and December 2007 were enrolled in this prospective study. After LSM was performed, patients attended regular follow-up as part of a surveillance program for the detection of HCC.Results: The mean age of the patients (767 men, 363 women) was 50.2 years and the median LSM was 7.7 kPa. Six hundred seventy two (59.5%) patients received antiviral treatment before or after enrollment. During the follow-up period (median, 30.7 months; range 24.0-50.9 months), HCC developed in 57 patients (2.0% per 1 person-year). The 1, 2, and 3-year cumulative incidence rates of HCC were 0.80%, 3.26%, and 5.98%, respectively. On multivariate analysis, together with old age, male gender, heavy alcohol consumption (> 80 g/day), serum albumin, and hepatitis B e antigen positivity, patients with a higher LSM value were at a significantly greater risk of HCC development, with a hazard ratio of 3.07 [95% CI, 1.01–9.31; P=0.047] when LSM value 8.1–13 kPa, 4.68 [95% CI, 1.40–15.64; P=0.012] when LSM value 13.1–18 kPa, 5.55 [95% CI, 1.53–20.04; P=0.009] when LSM value 18.1–23 kPa, and 6.60 [95% CI, 1.83–23.84; P=0.004] when LSM value >23 kPa, as compared to LSM value ≤8 kPa.Conclusion: Our data suggest that LSM could be a useful predictor of HCC development in patients with CHB.