Risk Assessment of Hepatocellular Carcinoma in General Population by Liver Stiffness in Combination with Controlled Attenuation Parameter using Transient Elastography: A Cross Sectional Study

Abstract

Background Hepatocellular carcinoma (HCC) in patients without hepatitis B (HBV) and-C virus (HCV) infection are increasing in Japan. Method for detecting high-risk liver diseases of HCC in general population has still not been established. Liver stiffness measurement (LSM) and Controlled Attenuation Parameter (CAP) using transient elastography (TE; FibroScan System) are useful for detecting liver fibrosis and steatosis. The aim of this study is to clarify TE for risk assessment of HCC in general population. Methods This cross-sectional study was performed for residents aged ≥ 40 years in an intermountain town in Japan with a population of 3,493. Blood laboratory testing included tumor markers, abdominal ultrasound (AUS), and TE was performed. Results Among 175 subjects (64 men, 111 women), TE was evaluated and three patients with HCC were detected by AUS. For detecting HCC, the cutoff value of LSM was 5.3 kPa sensitivity 100%, specificity 75%, AUROC 0.88). The combination of LSM and CAP (LSM > 5.3 kPa with any CAP and CAP > 248 dB/m with any LSM) could detect the high-risk liver diseases of HCC (HCC, nonalcoholic fatty liver/steatohepatitis, HBV or HCV related chronic viral hepatitis with alanine transaminase (ALT) > 30 IU/L for men or > 19 IU/L for women or cirrhosis of any cause) with high sensitivity (sensitivity 90%, specificity 55%, positive predictive value 10%, negative predictive value 99%, P = 0.006). Conclusion The combination of LSM and CAP can be useful in detecting high-risk liver diseases of HCC out of general population.

Association of metabolic syndrome with the risk of developing liver disease in chronic hepatitis B patients

“…Metabolic syndrome influences the development of hepatic steatosis by fluxing the circulatory system with VLDL and small dense (sd)-LDL, generation of reactive oxygen species and induction of non-alcoholic fatty liver (Sugihara et al, 2016). VLDL and sd-LDL are precursors for the packaging of the viral outer protein coat, which is required for the virulence and replication of the virus (Li and Zhao, 2017).…”

Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area

“…The CAP in combination with liver stiffness measurement (LSM) could be useful to assess the risk of HCC occurrence according to the findings of a study on a general population cohort without HBV or HCV infection and in a cohort with NAFLD and chronic HCV infection [ 63 , 67 , 68 ]. Due to the relatively widely set reference values (LSM > 5.3 kPa with any CAP and/or CAP > 248 dB/m with any LSM in the study by Sugihara et al and LSM ≥ 8.0 kPa and CAP ≤ 221 dB/m in HCV patients and LSM ≥ 5.4 kPa and CAP ≤ 265 dB/m in NAFLD patients in the study by Izumi et al), the question arises regarding how many patients would actually remain outside the proposed cut-off values [ 67 , 68 ]. Observations regarding the association between the CAP and the HCC risk in patients who were treated with a nucleos(t)ide analogue and showed suppressed hepatitis B virus replication have also been reported by Oh et al and Mak et al [ 69 , 70 ].…”

Clinical Application of Liver Stiffness Measurement for Assessing the Risk of Hepatocellular Carcinoma

“…For studies that do not distinguish between etiologies, cross-sectional studies are most common. In 2017, Sugihara et al 21 published a study in which TE was performed in the Japanese general population aged 40 years and older. In this cross-sectional study of 181 patients, only three patients had HCC.…”