Mehta V, Goyal MK, Gupta YK, Gupta A, Khubber M, Sehgal T, Mehta P, Goyal O. Liver stiffness at baseline as a marker of hepatocellular carcinoma in cirrhosis: A matched analysis. World J Gastrointest Pathophysiol 2026; 17(2): 120603 [DOI: 10.4291/wjgp.v17.i2.120603]
Corresponding Author of This Article
Manjeet Kumar Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, 1 Akron General Avenue, Akron, OH 44308, United States. manjeetgoyal@gmail.com
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Gastroenterology & Hepatology
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research-article
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Mehta V, Goyal MK, Gupta YK, Gupta A, Khubber M, Sehgal T, Mehta P, Goyal O. Liver stiffness at baseline as a marker of hepatocellular carcinoma in cirrhosis: A matched analysis. World J Gastrointest Pathophysiol 2026; 17(2): 120603 [DOI: 10.4291/wjgp.v17.i2.120603]
Varun Mehta, Yogesh Kumar Gupta, Abhinav Gupta, Manisha Khubber, Prabhav Mehta, Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Manjeet Kumar Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 44308, United States
Tanisha Sehgal, Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Co-first authors: Varun Mehta and Manjeet Kumar Goyal.
Author contributions: Mehta V and Goyal MK provided equal contributions, meriting co-first authorship, including conceptualization of the study, design of the methodology, and drafting of the original manuscript; Gupta YK, Mehta V, Khubber M, Mehta P and Gupta A performed the investigation and data collation; Goyal MK, Mehta P and Sehgal T generated the visualization of data; all authors edited each subsequent version of the manuscript; Goyal O and Goyal MK supervised the study and validated the data; all authors read and approved the final version of the manuscript.
Institutional review board statement: The Institutional Review Board of Dayanand Medical College and Hospital, India provided approval for this study (Approval No. DMCH/IEC/2025/407).
Informed consent statement: The requirement for informed consent was waived due to the retrospective nature of study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Data are available upon reasonable request to Manjeet K Goyal or Varun Mehta.
Corresponding author: Manjeet Kumar Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, 1 Akron General Avenue, Akron, OH 44308, United States. manjeetgoyal@gmail.com
Received: March 3, 2026 Revised: April 13, 2026 Accepted: April 23, 2026 Published online: June 22, 2026 Processing time: 105 Days and 14.9 Hours
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.
Core Tip: Hepatocellular carcinoma (HCC) surveillance in cirrhosis remains imperfect, with a substantial proportion of tumors detected at advanced stages despite guideline-recommended ultrasound-based screening. In this matched case–control study, baseline liver stiffness measurement (LSM) assessed by transient elastography independently stratified HCC risk among patients with established cirrhosis. Higher LSM values were strongly associated with HCC, with excellent discriminative performance and a clinically relevant threshold identifying patients at particularly high risk. These findings support the integration of LSM into HCC risk stratification frameworks and suggest that liver stiffness–guided, individualized surveillance strategies may improve early detection in cirrhosis.
