Combined liver fibrosis–liver stiffness score improves HCC prediction in CHB patients
A two-step algorithm that incorporates the liver stiffness measurement hepatocellular carcinoma (LSM-HCC) score and enhanced liver fibrosis (ELF) score appears to improve the accuracy of predicting HCC in chronic hepatitis B (CHB) patients after antiviral treatment, according to a study from Hong Kong.
Researchers examined 453 CHB patients (mean age, 51.7 years; 74.4 percent male) at intermediate or high risk of HCC by LSM-HCC score (ie, ≥11 or above). All patients had previously underwent transient elastography examinations and were assessed by repeat transient elastography at least 3 years later. ELF score was evaluated by retrieving the stored serum samples 4 weeks within transient elastography examination.
The primary endpoint of incident HCC occurred in 45 patients (9.9 percent) during a mean follow-up of 56 months.
LSM-HCC score improved in 71.4 percent of patients in the cohort, remained static in 24.3 percent and deteriorated in 4.3 percent. Meanwhile, ELF score improved in 36.9 percent of patients, remained static in 57.8 percent and deteriorated in 5.3 percent.
The cutoff of LSM‐HCC score of 20 at baseline predicted HCC with sensitivity of 53.3 percent and specificity of 57.4 percent, whereas ELF score of 9.8 at baseline had 75.6-percent sensitivity and 40.0-percent specificity. The combination of the two scores yielded a sensitivity of 86.7 percent and negative predictive value (NPV) of 95.3 percent—higher than that of each score alone.
On Kaplan-Meier analysis, ELF score helped further differentiate the HCC risk in patients with intermediate risk by LSM-HCC score (p=0.026) but not in patients with high risk by LSM-HCC score (p=0.770).
Researchers underscored the need for further research to define the role of the two-step algorithm to guide the intensity of HCC surveillance.