Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct‐acting antivirals

Abstract

Prediction of hepatocellular carcinoma (HCC) development after sustained virological response (SVR) is clinically important, and the usefulness of noninvasive markers for prediction HCC have been reported. The aim of this study was to compare the prediction accuracy for HCC development by noninvasive markers. A total of 346 patients with chronic hepatitis C without history of HCC who achieved SVR through direct‐acting antivirals were included. Magnetic resonance elastography (MRE) and serum fibrosis markers were measured 12 weeks after the end of treatment, and the subsequent HCC development was examined. The mean observation period was 26.4 ± 7.9 months, and 24 patients developed HCC. Area under the receiver operating characteristic curve of liver stiffness by MRE, Wisteria floribunda agglutinin‐positive mac‐2 binding protein and FIB‐4 for predicting HCC within 3 years was 0.743, 0.697 and 0.647, respectively. The 1/2/3‐year rates of HCC development in patients with liver stiffness ≥3.75 KPa were 6.6%, 11.9% and 14.5%, whereas they were 1.4%, 2.5% and 2.5% in patients with liver stiffness <3.75 KPa (P < 0.001). Multivariate analysis revealed that liver stiffness ≥3.75 was an independent predictive factor for HCC development (hazard ratio, 3.51; 95% confidence interval, 1.24‐9.99). In subgroup analysis, there were 132 patients who were <73 years old and had liver stiffness <3.75 KPa, and no HCC development was observed in these patients. Diagnostic accuracy for predicting HCC development was higher in MRE than serum fibrosis markers and measurement of liver stiffness by MRE could identify patients with high and low risk of HCC development after SVR.

Impact of liver‐stiffness measurement on hepatocellular carcinoma development in chronic hepatitis C patients treated with direct‐acting antivirals: A systematic review and time‐to‐event meta‐analysis

“…Seven articles were subsequently excluded after reviewing the full text. Finally, the remaining eight eligible articles were included in this study 20–27 . Among them, Shili et al .…”

“…The characteristics of the eight studies are summarized in Table 1. Four were prospective studies 20,24–26 and four were retrospective observational studies 21–23,27 . The total number of patients in the eight studies was 3507, and the total number of patients without prior HCC history in the eight studies was 3398.…”

High values of liver stiffness play an important role in stratifying the risk of hepatocellular carcinoma in cirrhotic hepatitis C patients.

“…[31] Tamaki et al also recently described liver stiffness by resonance above 3.75 kPa after 12 weeks of successful HCV response as being an independent predictive factor for HCC occurrence. [32] The present study came upon a correlation of total bilirubin values and MELD score, markers of liver function with HCC occurrence, as previously reported. [33] In addition to the risk for developing HCC over time, some of these parameters (such as bilirubin levels, AFP, platelet count and MELD score) may be associated with the presence of HCC at the time of assessing patients with cirrhosis due to hepatitis C.…”

Scaling concepts in ’omics: nuclear lamin-B scales with tumor growth and predicts poor prognosis, whereas fibrosis can be pro-survival

“…One study that also identified pro-survival roles for fibrosis and myofibroblasts in a mouse model of pancreatic cancer also described a pro-survival role for vascular genes 58 . The most enriched Gene Ontology (GO) annotations in survival are indeed extracellular factors, exosomes, and metabolic pathways ( Non-invasive measurements of stiffness (MRE) and perfusion (various radiological methods) might help distinguish effects of acute stiffening from chronic stiffening which is a clear risk factor for cancer [66][67][68] .…”