Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Int. 2013 May;33(5):756-61. doi: 10.1111/liv.12118. Epub 2013 Feb 14.
Hepatic fibrosis stage is useful in assessing risk of hepatocellular carcinoma (HCC) occurrence.
To evaluate liver stiffness measurement (LSM), in addition to fibrosis stage, in risk assessment of long-term HCC occurrence for patients with chronic hepatitis C.
Consecutive patients with chronic hepatitis C, without past history and presence of HCC, with concomitant liver biopsy and LSM were enrolled in this study. All patients attended regular surveillance for HCC development every 3-12 months. The medical records were reviewed. Follow-up LSM was performed at least 1 year later.
One hundred and ninety-eight patients (M/F: 112/86) with reliable LSM results were enrolled. Ten patients developed HCC in a median follow-up period of 47.8 months. For patients with initial LSM >24 kPa, 12-24 kPa, and <12 kPa, 5- year HCC incidence was 45.1%, 9.5% and 0.9% respectively. Multivariate analysis showed patients with LSM>24 kPa and patients with LSM 12-24 kPa had higher risks of HCC development (HR: 24.6, CI: 2.7-220.4 and HR:11.7, CI:1.3-105.2). Patients without sustained virological response after treatment also had higher risk of HCC occurrence (HR: 9.7, CI: 1.1-82.2). Among 106 patients with follow-up LSM, there was a higher risk of HCC development for patients with LSM>12 kPa in the initial and follow-up LSM.
As an alternative of fibrosis stage, initial LSM is useful as a non-invasive method in risk assessment of HCC occurrence for patients with chronic hepatitis C. Serial follow-up LSM>12 kPa carries higher risk of HCC development.
肝纤维化分期有助于评估肝细胞癌（HCC）发生的风险。
评估肝脏硬度测量（LSM）在慢性丙型肝炎患者中除纤维化分期外，对长期 HCC 发生风险的评估作用。
本研究纳入了连续的慢性丙型肝炎患者，无既往 HCC 病史和现病史，同时进行了肝活检和 LSM。所有患者均定期接受 HCC 发生的监测，每 3-12 个月一次。回顾病历记录。在至少 1 年后进行了随访 LSM。
本研究纳入了 198 例（男性/女性：112/86）具有可靠 LSM 结果的患者。在中位随访 47.8 个月期间，有 10 例患者发生 HCC。对于初始 LSM>24 kPa、12-24 kPa 和<12 kPa 的患者，5 年 HCC 发生率分别为 45.1%、9.5%和 0.9%。多变量分析显示，LSM>24 kPa 的患者和 LSM 12-24 kPa 的患者 HCC 发生风险更高（HR：24.6，CI：2.7-220.4 和 HR：11.7，CI：1.3-105.2）。治疗后未获得持续病毒学应答的患者 HCC 发生风险也更高（HR：9.7，CI：1.1-82.2）。在 106 例有随访 LSM 的患者中，初始和随访 LSM 中 LSM>12 kPa 的患者 HCC 发生风险更高。
作为纤维化分期的替代方法，初始 LSM 是一种有用的非侵入性方法，可用于评估慢性丙型肝炎患者 HCC 发生的风险。连续随访 LSM>12 kPa 提示 HCC 发生风险更高。
