Prediction of HCC Using Liver Stiffness Measurements

Advanced liver fibrosis or cirrhosis is one of the most important risk factors of hepatocellular carcinoma (HCC) in chronic liver diseases and an accurate assessment of liver fibrosis facilitates precise risk prediction for HCC. Non-invasive assessment of liver fibrosis via liver stiffness measurement (LSM) with transient elastography has been one of the most rapidly advancing fields in hepatology over the last decade. LSM is a well-validated non-invasive tool for advanced liver fibrosis and cirrhosis and LS highly correlates with the future risk of HCC. Meanwhile, LSM plays an important role before, during, and after HCC treatment. Moreover, LSM-based risk prediction models provide an accurate risk-stratification before and after antiviral treatment. Thus, several LSM-based HCC risk prediction models (namely, LSM-HCC score, modified REACH-B) are useful to prioritize patients for HCC surveillance. LSM also helps predict HCC treatment outcomes, including HCC recurrence, postoperative complications and survival. While earlier studies suggested an increased risk to develop HCC starting from a cutoff value >20 kPa, this threshold has been continuously lowered to 13 kPa, depending on the etiology of the liver disease. There is also a diagnostic role of elastography for HCC. Two-dimensional elastography is used for differentiating benign and malignant liver tumors. Hence patients either at risk of HCC or already developed HCC should receive LSM on a regular basis.