Gaspar Rui, Mota Joana, Almeida Maria João, Silva Marco, Macedo Guilherme
Gastroenterology and Hepatology, Centro Hospitalar de São João, 4200 Porto, Portugal.
Diagnostics (Basel). 2024 Dec 20;14(24):2867. doi: 10.3390/diagnostics14242867.
BACKGROUND/OBJECTIVES: Hepatocellular carcinoma (HCC) is the sixth most common cause of cancer worldwide. More than 90% of cases occur in cirrhotic patients, with the degree of fibrosis being the main risk factor for the development of HCC. Liver biopsy is the gold-standard for fibrosis assessment, but it is an invasive procedure. Liver stiffness measurement (LSM) has shown high accuracy for diagnosing liver cirrhosis, as well as for predicting decompensation and HCC development. More recently, spleen stiffness measurement (SSM) has presented excellent results for ruling in/out high-risk varices and the presence of clinical significant portal hypertension. The aim of our study was to evaluate the relationship between LSM and SSM and the risk of hepatocellular carcinoma.
A prospective study on cirrhotic patients was performed in a tertiary center from January 2020 to May 2024. All patients were submitted to liver and spleen elastography (with a new probe of 100 Hz) by the same blinded operator and were treated in the same institution for the development of hepatocellular carcinoma.
We included 299 cirrhotic patients, 75.9% male, with a mean age of 61.8 years (±10.0). The median value of LSM was 25.7 kPa [4.5-75.0] and that of SSM was 44.6 kPa [7.9-100.0]. The median follow-up time was 505 days [114.0-1541.0]. During this period, 18 patients developed HCC, with a median time to HCC diagnosis after LSM and SSM of 321 days [63.0-1227.0]. LSM was the only factor associated with the development of HCC ( = 0.002) with an AUC of 0.715. On the other hand, SSM was not associated with the development of HCC.
We found that the risk of developing HCC is associated with liver fibrosis but not with portal hypertension (assessed using SSM).
背景/目的：肝细胞癌（HCC）是全球第六大常见癌症病因。超过90%的病例发生在肝硬化患者中，纤维化程度是HCC发生的主要危险因素。肝活检是纤维化评估的金标准，但它是一种侵入性操作。肝脏硬度测量（LSM）在诊断肝硬化以及预测失代偿和HCC发生方面已显示出高准确性。最近，脾脏硬度测量（SSM）在排除/诊断高危静脉曲张和临床显著性门静脉高压的存在方面取得了优异结果。我们研究的目的是评估LSM与SSM之间的关系以及肝细胞癌的风险。
2020年1月至2024年5月在一家三级中心对肝硬化患者进行了一项前瞻性研究。所有患者均由同一位盲法操作者进行肝脏和脾脏弹性成像检查（使用100Hz的新探头），并在同一机构接受肝细胞癌发生情况的治疗。
我们纳入了299例肝硬化患者，男性占75.9%，平均年龄为61.8岁（±10.0）。LSM的中位数为25.7kPa[4.5 - 75.0]，SSM的中位数为44.6kPa[7.9 - 100.0]。中位随访时间为505天[114.0 - 1541.0]。在此期间，18例患者发生了HCC，LSM和SSM后至HCC诊断的中位时间为321天[63.0 - 1227.0]。LSM是与HCC发生相关的唯一因素（P = 0.002），曲线下面积（AUC）为0.715。另一方面，SSM与HCC的发生无关。
我们发现发生HCC的风险与肝纤维化相关，而与门静脉高压（使用SSM评估）无关。
