Liver stiffness at baseline as a marker of hepatocellular carcinoma in cirrhosis: A matched analysis.

Abstract

Background: Early hepatocellular carcinoma (HCC) detection in cirrhosis remains suboptimal despite semi-annual ultrasound and alpha-fetoprotein surveillance. Advanced fibrosis is a central driver of hepatocarcinogenesis, and liver stiffness measurement (LSM) is a non-invasive measure of liver stiffness that may be associated with HCC risk.

Aim: To evaluate whether LSM by transient elastography (TE) is associated with the presence of HCC among patients with established cirrhosis.

Methods: A retrospective, matched case-control study at a tertiary liver center including adults with cirrhosis and a valid TE (≥ 10 valid acquisitions, interquartile range < 30%, success rate > 60%) was conducted. Cirrhotic patients with diagnosed HCC per standard guidelines were frequency matched for age, sex, etiology, and Child-Pugh class with controls (cirrhotic patients without HCC). Multivariable logistic regression tested the association between LSM and HCC. Discrimination and cut-off points were assessed using receiver operating characteristic (ROC) analysis and Youden's index.

Results: A total of 262 patients (133 with HCC; 129 controls) were enrolled. Median LSM was higher in the HCC cohort than in controls (31.7 kPa vs 22.6 kPa; P < 0.001). Multivariate regression analysis revealed that only LSM was significantly associated with HCC (adjusted odds ratio 1.09; 95%CI: 1.05-1.13; P = 0.0001). A cut-off of ≥ 47 kPa had excellent discriminatory power (area under the ROC curve: 0.88; 95%CI: 0.84-0.93).

Conclusion: A liver stiffness threshold of approximately 47 kPa may serve as a marker associated with risk of HCC, justifying intensified screening in high-risk cirrhosis; prospective validation, integration with multivariable risk models, and cost-effectiveness analyses remain essential.