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

Table 1 Risk of bias assessment according to Quality Assessment of Prognostic Accuracy Studies tool for quality assessment of prognostic accuracy studies

Ref.	Risk of bias
	Participants	Index test	Outcome	Flow and timing	Analysis
Gyotoku et al[32], 2022	Unclear	Low	Unclear	Low	Low
Hamada et al[31], 2018	Unclear	Low	Unclear	High	Unclear
Kumada et al[35], 2022	Low	Low	Unclear	Low	Low
Masaoka et al[33], 2023	Unclear	Low	Unclear	Low	Low
Nicoletti et al[34], 2023	High	Low	Unclear	Low	Low

Table 2 Concerns about applicability according to Quality Assessment of Prognostic Accuracy Studies tool for quality assessment of prognostic accuracy studies

Ref.	Applicability concerns
	Participants	Index test	Outcome	Flow and timing
Gyotoku et al[32], 2022	Low	Low	Low	Low
Hamada et al[31], 2018	High	Low	Low	Low
Kumada et al[35], 2022	Low	Low	Low	Low
Masaoka et al[33], 2023	Low	Low	Low	Low
Nicoletti et al[34], 2023	Low	Low	Low	Low

Table 3 Study characteristics of included publications

Ref.	Country	Study design	Patients, n	SWE evaluation	Follow-up time
Hamada et al[31], 2018	Japan	Retrospective	196	24 wk	26 (5-109) mo
Gyotoku et al[32], 2022	Japan	Retrospective	229	EOT, 12 and 24 wk	32.6 ± 19.5 mo
Kumada et al[35], 2022	Japan	Prospective	525	12 wk	5.0 (4.0-5.4) yr
Masaoka et al[33], 2023	Japan	Retrospective	279	EOT, 12 and 24 wk	33.8 (6-85) mo
Nicoletti et al[34], 2023	Italy	Prospective	229	24 wk	3.25 (0.5-4.7) yr

Continuous variables are described as mean ± standard deviation or median and interquartile range, when reported. EOT: End of treatment; SWE: Shear-wave elastography.

Table 4 Baseline patient characteristics in the included publications

Ref.	Age in yr	Sex as male/female	Fib4 score	HCC, n	Time to HCC in mo
Hamada et al[31], 2018	62 (29-89)	89/107	2.56 (0.39-12.13)	8	28 (6-46)
Gyotoku et al[32], 2022	66 (21-84)	93/136	3.49 (0.30-19.10)	8	21.3
Kumada et al[35], 2022	72 (65-79)	227/298	2.73 (1.90-4.23)	21	Not reported
Masaoka et al[33], 2023	66 (21-86)	118/161	3.41 (0.23-22.00)	12	33.8 (6-85)
Nicoletti et al[34], 2023	67 ± 11	136/93	5.77 ± 5.40	30	24 ± 14.5

Continuous variables are described as mean ± standard deviation or median and interquartile range, when reported. Fib4 score: Fibrosis-4; HCC: Hepatocellular carcinoma.

Table 5 Predictive liver stiffness threshold for development of hepatocellular carcinoma after sustained virologic response and relative adjusted hazard ratio and area under the curve

Ref.	LS threshold in kPa	SWE timing	aHR (95%CI)	P value	AUC
Hamada et al[31], 2018	≥ 11.0	24 wk after EOT	28.71 (2.58-320.03)	0.006	0.93
Gyotoku et al[32], 2022	Not reported	24 wk after EOT	Not reported	Not reported	0.86
Kumada et al[35], 2022	11.7	Baseline	28.08 (5.53-132.60)	< 0.001	0.93
Masaoka et al[33], 2023	7.0	12 wk after EOT	Not reported	Not reported	Not reported
Nicoletti et al[34], 2023	ΔLS < 20%	Baseline and 48 wk after EOT	2.98 (1.01-8.11)	0.03	0.69

ΔLS = Baseline liver stiffness (LS) – LS at 48 wk. 95%CI: 95% Confidence interval; aHR: Adjusted hazard ratio; AUC: Area under the curve; EOT: End of treatment; FU: Follow-up; HCC: Hepatocellular carcinoma; SVR: Sustained virological response; SWE: Shear-wave elastography.