Does transient elastography (FibroScan®) have a role in decision making in hepatocellular carcinoma?

Abstract

Objectives: Portal hypertension has been reported as a negative prognostic factor and a relative contraindication for liver resection. This study considers a possible role of fibrosis evaluation by transient elastography (FibroScan(®)) and its correlation with portal hypertension in patients with cirrhosis, and discusses the use of this technique in planning therapeutic options in patients with hepatocellular carcinoma (HCC).

Methods: A total of 77 patients with cirrhosis, 42 (54.5%) of whom had HCC, were enrolled in this study during 2009-2011. The group included 46 (59.7%) men. The mean age of the sample was 65.2 years. The principle aetiology of disease was hepatitis C virus (HCV)-related cirrhosis (66.2%). Liver function was assessed according to Child-Pugh classification. In all patients liver stiffness (LS) was measured using FibroScan(®). The presence of portal hypertension was indirectly defined as: (i) oesophageal varices detectable on endoscopy; (ii) splenomegaly (increased diameter of the spleen to ≥ 12 cm), or (iii) a platelet count of <100,000 platelets/mm(3).

Results: Median LS in all patients was 27.9 kPa. Portal hypertension was recorded as present in 37 patients (48.1%) and absent in 40 patients (51.9%). Median LS values in HCC patients with and without portal hypertension were 29.1 kPa and 19.6 kPa, respectively (r = 0.26, P < 0.04). Liver stiffness was used to implement the Barcelona Clinic Liver Cancer algorithm in decisions about treatment.

Conclusions: The evaluation of liver fibrosis by transient elastography may be useful in the follow-up of patients with cirrhosis and a direct correlation with portal hypertension may aid in the evaluation of surgical risk in patients with HCC and in the choice of alternative therapies.

Figure 1

Median liver stiffness in patients with hepatocellular carcinoma was higher in patients with than without portal hypertension (29.1 kPa vs. 19.6 kPa; P < 0.04)

Figure 2

A direct correlation between liver stiffness (LS) and Child–Pugh class was found: patients in Child–Pugh classes B and C showed the highest LS values (P < 0.005)

Figure 3

Liver stiffness (LS) measurements correlated with Model for End-stage Liver Disease (MELD) scores: the median LS value in patients with MELD scores of >10 was 29.07 kPa, whereas the median LS value in patients with MELD scores of ≤10 was 22.91 kPa (P < 0.02)