Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication: A systematic review and meta-analysis

Abstract

Background: Direct-acting antiviral agents (DAAs) are highly effective treatment for chronic hepatitis C (CHC) with a significant rate of sustained virologic response (SVR). The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis progression. The assessment of fibrosis degree can be performed with transient elastography, magnetic resonance elastography or shear-wave elastography (SWE). Liver elastography could function as a predictor for hepatocellular carcinoma (HCC) in CHC patients treated with DAAs.

Aim: To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus (HCV).

Methods: A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV clearance. In accordance with the study protocol, a qualitative and quantitative analysis of the evidence was planned.

Results: At baseline and after 12 wk of follow-up, a trend was shown towards greater liver stiffness (LS) in those who go on to develop HCC compared to those who do not [baseline LS standardized mean difference (SMD): 1.15, 95% confidence interval (95%CI): 020-2.50; LS SMD after 12 wk: 0.83, 95%CI: 0.33-1.98]. The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source data. There was a statistically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not (0.64; 95%CI: 0.04-1.24).

Conclusion: SWE could be a promising tool for prediction of HCC occurrence in patients treated with DAAs. Further studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

Keywords: Hepatitis C virus; Hepatocellular carcinoma; Shear-wave elastography; Sustained virologic response.

Figure 1

PRISMA study selection flow diagram.

Figure 2

Standardized mean difference of liver stiffness. A: Standardized mean difference (SMD) of liver stiffness (LS) at baseline in patients who did or did not develop hepatocellular carcinoma (HCC) during follow-up; B: SMD of LS at 12 wk after sustained virological response (SVR) in patients who did or did not develop HCC during follow-up; C: SMD of LS at 24 wk after SVR in patients who did or did not develop HCC during follow-up. 95%CI: 95% Confidence interval.