Using transient elastography to predict hepatocellular carcinoma recurrence after radiofrequency ablation

Lee, Yu Rim; Park, Soo Young; Kim, Seung Up; Jang, Se Young; Tak, Won Young; Kweon, Young Oh; Park, Jun Yong; Ahn, Sang Hoon; Han, Kwang Hyub; Hur, Keun

doi:10.1111/jgh.13644

Cited by 22 publications

(26 citation statements)

References 37 publications

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“…LS measured by two-dimensional shear-wave elastography has been reported as a significant predictive factor for OS after RFA for HCC 29 . However, in other studies in Korea, LS measured by TE or ARFI elastography did not have effective prediction performance for OS in HCC patients who received RFA 12,18 . In our study, we identified that an ARFI velocity cut-off value of 1.5 m/s for LS could significantly predict the OS of patients who underwent RFA for HCC.…”

Section: Discussionmentioning

confidence: 69%

“…www.nature.com/scientificreports www.nature.com/scientificreports/ (including tumor size, number, tumor cell differentiation, vascular invasion, extra-hepatic metastasis, and serum AFP level), liver functional reserve (such as serum albumin level, platelet count, and portal hypertension), and field factors in the background liver (including the grade of hepatic inflammation and steatosis and the stage of liver fibrosis) 12,18,[25][26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

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Liver stiffness measured by acoustic radiation force impulse elastography predicted prognoses of hepatocellular carcinoma after radiofrequency ablation

Lee

Chiou

Chiu

et al. 2020

Sci Rep

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The prognostic factors of patients who undergo radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is not fully elucidated. We aimed to investigate the role of liver stiffness (LS) and spleen stiffness (SS) measured by acoustic radiation force impulse (ARFI) elastography in determining the prognoses of patients with HCC after RFA. We prospectively enrolled 173 patients with HCC who underwent ARFI elastography for measurement of LS and SS on the same day of RFA. Overall survival (OS), recurrence-free survival (RFS) after adjusting for competing mortality, and presence of hepatic decompensation were investigated. Patients with LS > 1.5 m/s had significantly shorter OS and RFS than their counterparts. Anti-viral treatment (hazard ratio [HR]: 0.396, p = 0.015) and LS > 1.5 m/s (HR 4.105, p = 0.028) correlated with OS by a multivariate analysis. Besides, serum alpha fetoprotein >10 ng/mL and LS > 1.5 m/s independently predicted poorer RFS. On the other hand, anti-viral treatment (HR: 0.315, p = 0.010), creatinine > 1.5 mg/dL (HR: 9.447, p = 0.006), and SS > 2.7 m/s (HR: 2.869, p = 0.044) predicted a higher risk of hepatic decompensation. In conclusion, LS but not SS measured by ARFI elastography predicted tumor recurrence and OS in RFA-treated HCC; whereas, SS predicted development of hepatic decompensation in these patients. Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and contributes to enormous cancer-related deaths annually 1. Thanks to the well-developed principles of surveillance for HCC in high-risk patients, a large number of patients are diagnosed in the early stage and can be treated by loco-regional ablative therapies, such as radiofrequency ablation (RFA) 2,3. Nevertheless, the recurrence rates of HCC after RFA are significantly higher than those of surgical resection, in spite of the comparable survival benefit and less serious adverse effects 4-6. This affects the long-term prognosis of these patients 7. Besides tumor characteristics, field factors such as the stage of liver fibrosis and the degree of portal hypertension are important risk factors for developing HCC recurrence after treatment 8-10. Acoustic radiation force impulse (ARFI) elastography is a reliable tool for assessing the degree of liver stiffness (LS) and predicting the complications of patients with liver cirrhosis 11 .

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Liver stiffness measured by acoustic radiation force impulse elastography predicted prognoses of hepatocellular carcinoma after radiofrequency ablation

Lee

Chiou

Chiu

et al. 2020

Sci Rep

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“…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'.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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

Zhang

Chen

et al. 2021

International Journal of Hyperthermia

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Background: In patients with stage 0-A (as per Milan criteria) hepatocellular carcinoma (HCC) imageguided ablation is less invasive and requires shorter hospitalization than resection, but long-term prognosis is poorer. This meta-analysis was conducted to investigate whether liver stiffness measurement (LSM) could be used to predict prognosis in HCC patients after tumor ablation. Methods: A literature search was conducted for all studies published till July 2020 in PubMed, Web of Science, Cochrane Library and EMBASE. Studies were included if they investigated the association between pretreatment LSM and prognosis in HCC patients treated with ablation. Subgroup analysis, meta-regression, publication bias assessment and sensitivity were conducted. Results: Eight studies (with a total of 1276 HCC patients) were included in this meta-analysis. All patients were treated with radiofrequency ablation. Pooled results showed that high pretreatment LSM were associated with poor overall survival (OS) (hazard ratio [HR] ¼ 4.31, 95% confidence interval [CI]: 2.27-8.20, p < .001) and recurrence-free survival (RFS), regardless of whether LSM was considered as a categorical variable (HR ¼ 2.63, 95% CI ¼ 1.63-4.22, p < .001) or as a continuous variable (HR ¼ 1.02, 95% CI ¼ 1.01-1.04, p ¼ .003). Among studies treating LSM value as a categorical variable, liver stiffness measured using acoustic radio force impulse (ARFI) or transient elastography (TE) was significantly associated with RFS, but not liver stiffness measured using two-dimensional shear wave elastography (SWE). Conclusions: High baseline LSM value appears to be associated with poor prognosis in HCC patients treated with radiofrequency ablation.

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“…LSM is also found useful to predict de novo recurrence after curative treatment (e.g. resection or radiofrequency ablation) for HCC.…”

Section: Physical Modalitiesmentioning

confidence: 99%

Non‐invasive assessments for liver fibrosis: The crystal ball we long for

Wong

2018

J of Gastro and Hepatol

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Non‐invasive assessment of liver fibrosis has been one of the most rapidly advancing fields in hepatology in the last decade. Progressive liver fibrosis results in cirrhosis, hepatocellular carcinoma (HCC), and various liver‐related complications in essentially all chronic liver diseases. Assessment of liver fibrosis allows clinicians to determine the prognosis, need of treatment, disease progression, and response to treatment in patients with chronic liver disease. Liver biopsy has been the gold standard in last few decades and most adopted diagnostic tool in clinical trials. Nonetheless, it is impractical to apply the test in a large number of patients or to do it serially. Hence, various non‐invasive assessments have been developed and adopted in some international management guidelines. Liver stiffness measurement (LSM) with transient elastography is one of the most widely validated non‐invasive assessments for liver fibrosis. It is an accurate and reproducible method to predict advanced fibrosis in chronic hepatitis B. Using transient elastography, it is possible to perform repeated liver fibrosis assessments on a large number of asymptomatic patients. The key challenge of his tool is the confounding effect of alanine aminotransferase (ALT) level, such that decrease in LSM may only reflect ALT normalization, hence not accurate enough to indicate regression of liver fibrosis. This may be partially handled by combining LSM with a serum‐based formula, which is independent of ALT such as the Forns index and enhanced liver fibrosis test. An LSM‐based HCC risk score is useful to prioritize patients for HCC surveillance.

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Using transient elastography to predict hepatocellular carcinoma recurrence after radiofrequency ablation

Abstract: Findings of this study suggest that LS measurement using TE can be a useful predictor of HCC recurrence after RFA.

Cited by 22 publications

References 37 publications

Liver stiffness measured by acoustic radiation force impulse elastography predicted prognoses of hepatocellular carcinoma after radiofrequency ablation

Liver stiffness measured by acoustic radiation force impulse elastography predicted prognoses of hepatocellular carcinoma after radiofrequency ablation

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

Non‐invasive assessments for liver fibrosis: The crystal ball we long for

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