Transient Elastography can Predict the Risk of Hepatocellular Carcinoma in Egyptian Patients with Chronic Hepatitis C

Abstract

AIM: HCC is one of the most serious causes of cancer mortality in Egypt due to the burden of HCV, liver stiffness measured by elastography may be useful in demarcating patients at risk for HCC development. This study is aim to verify whether FibroScan could be used as a tool for identifying HCV positive patients who are at high risk of developing HCC. METHODS: The study included 150 patients with proven chronic hepatitis C (CHC) without HCC (group I), and 100 patients with CHC and HCC (groupII). HCV patients were diagnosed by HCV Ab; serum HCV RNA and US liver biopsy. HCC was diagnosed based on alphafeto-protein, triphasic spiral CT with double contrast and US guided biopsy when needed. Liver stiffness measurement by transient elastography (FibroScan®- Echosens) was carried out for all the patients included in the study. Multivariate logistic regression was applied to assess the association with HCC presence. We computed ROC curve concerning the prediction of HCC. We calculated stratum-specific likelihood ratios (SSLR) for the two groups. RESULTS: Multivariate analysis showed a positive correlation between the liver stiffness & the presence of HCC & the number of focal lesions (P<0.001). SSLR for HCC presence by liver stiffness was 0.0128 in <10 kPa, 0.8189 in 10.1 to 15 kPa, 4.285 in 15.1 to 25 kPa, and 15 in >25 kPa. When using ROC curve, stiffness showed high significant sensitivity 97% and specificity 84% at the level of >12 kpa. The positive predictive value was 85% and negative predictive value was 96.6 %. Univariate analyses showed that the risk of HCC increased in accordance with SSLR; older age, male gender, clinical cirrhosis, lower serum albumin level, higher total bilirubin level, higher ALT & AST levels & lower prothrombin p<0.001. It also showed high significant negative correlation with PC% and albumin. CONCLUSION: Liver stiffness measured by FibroScan® could be a useful predictor of HCC development in patients with CHC. Patients expressing fibroscan score >25 kPa. and SSLR >4.1 are in need for closer follow up.