2D shear wave elastography and risk for de novo hepatocellular carcinoma in patients with advanced chronic liver disease

Background and Aims Liver cirrhosis is the most important risk factor in the development of de novo hepatocellular carcinoma (HCC) regardless of etiologies. Early non-invasive screening for cirrhosis using liver stiffness (LS) may also give information on the risk of HCC. This is the large-scale international multicenter study to evaluate clinically relevant end-point in liver cirrhosis using two-dimensional real-time shear wave elastography (L-SWE).

Method Chronic liver disease patients were screened from 16 centers from Europe and China. Besides, they were included if they had valid 2D-SWE at baseline. Clinical and laboratory parameters were assessed at baseline. We conducted the follow-up regularly after first assessment. De novo HCC was diagnosed according to the 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Univariate and multivariate logistic regression model were used to explore risk factors of de novo HCC. Area under the receiver operating characteristic curve (AUROC) and Youden index were analyzed to find out the optimal cutoff for LS with SWE.

Results A total of 1881 were included in the study with a median follow-up of 2.3 years. Eighty-five (4.5 %) patients were diagnosed with de novo HCC, and had a doubled median 2D-SWE value than those without HCC (22.0 vs. 11.1, p  <  0.001). L- SWE (OR: 1.013, p=0.022) was independently associated with developing de novo HCC in multivariate analysis. Age, gender and platelets count were also found independent risk factors for de novo HCC development. The AUROC of L-SWE combined model was 0.756 (95 %CI: 0.716 - 0.796), which was significantly higher than the MELD and Child-Pugh scores in predicting de novo HCC. And the model fits good in the calibration plot. At the best cut-off of 15kPa, a 77 % of sensitivity and a 63 % of specificity were obtained, with a negative predictive value of up to 98 %. Patients with L-SWE values above the cutoff (≥ 50 kPa, OR:3.866, p < 0.001) and lower platelet counts ( < 170G/L) were markedly associated with de novo HCC. A cut-off value of 50 years old and male sex were also established for the risk stratification algorithm.

Conclusion The L-SWE is associated with de novo HCC with the optimal cutoff of 15 kPa, combined with PLT of 170G/L, age of 50 and male sex. Three significantly different de nove HCC risk groups could be classified. The algorithm could be used as a convenient diagnostic tool to stratify the risk of de novo HCC.

Publication History

Article published online:
04 January 2021