Transient elastography predicts survival after radiofrequency ablation of hepatocellular carcinoma developing on cirrhosis

Abstract

Background and aimThe prognostic value of transient elastography (TE) in cirrhotic patients with hepatocellular carcinoma (HCC) treated by percutaneous radiofrequency ablation (RFA) is currently unknown.Method(s)We included patients with histologically proven cirrhosis and with a first diagnosis of HCC inside Milan criteria treated by percutaneous RFA, and with TE available the year before treatment with 10 shots and interquartile range/median < 30%. Association between variables and clinical events was assessed by the Kaplan–Meier method with the log–rank test and using Cox univariate and multivariate analyses.ResultsOne hundred fifty‐nine patients were included, with a median age of 65 years; 77.4% were men. Causes of cirrhosis were alcohol consumption (48.1%), hepatitis C (43.7%), hepatitis B (12.7%), and non‐alcoholic steatohepatitis (32.3%). Median value of TE was 26 kPa (4–75 kPa). Overall survival at 1, 2, and 5 years was, respectively, 93%, 81%, and 44%; overall recurrence was 28%, 49%, and 80%. The TE value was not associated with tumor recurrence (0.13). In contrast, in univariate analysis, TE value, age, Child–Pugh B, and alkaline phosphatase were predictive factors in overall survival. In multivariate analysis, TE value (hazards ratio [HR] = 1.02, 95% confidence interval (IC): 1.01–1.04, 0.001), age (HR = 1.05, 95% IC: 1.03–1.08, P = 0.00006), and Child–Pugh B score (HR = 2.78, 95% IC: 1.27–6.08, P = 0.01) were independently associated with higher risk of death. A TE value ≥ 40 kPa was associated with shorter median overall survival (34 months) compared to a TE value < 40 kPa (59 months, P = 0.0008).Conclusion(s)Transient elastography (TE) predicts overall survival but not tumor recurrence in cirrhotic patients with HCC treated by RFA.

Prognostic value of liver stiffness measurement in patients with hepatocellular carcinoma (HCC) treated by radiofrequency ablation: a meta-analysis

“…Of these, 576 were excluded by screening titles and abstracts (because they were either conference abstracts, letters, reviews, case reports or irrelevant studies), leaving 26 potentially relevant full-text articles. Eventually, eight studies [11][12][13][14][15][16][17][18] with a total of 1276 patients, were included in this meta-analysis. One of the included studies (Yoon et al [18]) compared the predictive value LSM evaluated by ARFI elastography versus TE; we treated this article as two separate studies -'Yoon 2018 AFFI' and 'Yoon 2018 TE'.…”

“…Of the eight studies, five were prospective and three were retrospective observational studies. All eight studies used ultrasound-based techniques for measurement of liver stiffness: five studies [11,[14][15][16]18] used TE, two studies [12,17] used SWE and two studies [13,18] used ARFI. No studies that used MRE for measurement of liver stiffness and examined its association with prognosis had been reported until the day of our literature search.…”

“…No studies that used MRE for measurement of liver stiffness and examined its association with prognosis had been reported until the day of our literature search. Notably, seven of the eight studies were from Asian countries (China and Korea); one study [16] was from France. HBV was the most common cause of HCC in our studies, which is to be expected, given that chronic HBV infection is a leading cause of HCC in Eastern Asian countries.…”

“…HBV was the most common cause of HCC in our studies, which is to be expected, given that chronic HBV infection is a leading cause of HCC in Eastern Asian countries. While three studies [11,15,16] fitted LSM as a continuous variable in a multivariable model, the other five [12][13][14]17,18] treated LSM as a categorical variable, using cutoff values identified by receiver operating characteristic curve analysis. All eight studies in this meta-analysis were identified as being of moderate quality with scores in the range of 5-6.…”

Predictive factors for hepatocellular carcinoma recurrence after curative treatments

“…The development of non-invasive methods to assess the degree of liver fibrosis including blood marker tests and transient elastography has revolutionized the assessment of liver fibrosis over the last decade [176] . Recent data reported the role of transient elastography in predicting intrahepatic distant recurrence of HCC following RFA [177] . In conclusion, RFA is a potential curative modality for cirrhotic patients with early HCC.…”