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

Table 1 Baseline characteristic of patients, n (%)/mean ± SD/median (interquartile range)

Characteristics	CLD with HCC, n = 133	CLD without HCC, n = 129	P value
Age (years)	51 ± 11	52 ± 9	0.19
Sex (male:female)	96:37	92:37	0.99
Duration of cirrhosis (years)	5.2 ± 3.6	5.8 ± 3.2	0.15
Etiology
Alcohol	42 (31.6)	39 (30.2)	0.81
MASLD	41 (30.8)	37 (28.7)	0.72
MetALD	19 (14.3)	19 (14.7)	0.93
HBV	7 (5.3)	9 (7.0)	0.56
HCV	18 (13.5)	23 (17.8)	0.34
Others	6 (4.5)	2 (1.6)	0.16
Severity
CP-A	77 (57.9)	69 (53.5)	0.77
CP-B	31 (23.3)	36 (27.9)
CP-C	25 (18.8)	24 (18.6)
History of decompensation during disease course
Ascites	27 (20.3)	29 (22.5)	0.78
Jaundice	29 (21.8)	33 (25.6)	0.57
Variceal bleed	33 (24.8)	29 (22.5)	0.77
Esophageal	21 (15.8)	19 (14.7)	0.80
Gastric	12 (9.0)	8 (6.2)	0.39
Ectopic	0	2 (1.6)	0.242
Hepatic encephalopathy	19 (14.3)	29 (22.6)	0.12
Presentation at diagnosis of cirrhosis
Jaundice	24 (18.0)	27 (20.9)	0.56
Bleed	33 (24.8)	24 (18.6)	0.24
Hepatic encephalopathy	4 (3.0)	7 (5.4)	0.502
Incidental	56 (42.1)	49 (38.0)	0.51
Lab parameters
Hemoglobin (g/dL)	11.4 ± 2.2	11.3 ± 1.4	0.66
Platelet count (103/µL)	116.9 ± 56.1	112.2 ± 52.5	0.23
Bilirubin (mg/dL)1	1.27 (0.9-2.6)	2.4 (1.0-3.8)	0.06
Albumin (g/dL)	3.8 ± 0.6	3.7 ± 0.6	0.18
Creatinine (mg/dL)	0.8 ± 0.4	0.9 ± 0.3	0.12
INR	1.9 ± 0.3	1.8 ± 0.4	0.23
Alanine transaminase (IU/L)	69.6 ± 34.9	53.7 ± 19.3	0.06
Aspartate transaminase (IU/L)	60.1 ± 29.1	46.9 ± 29.1	0.01

¹Bilirubin compared using Mann-Whitney U test. Categorical variables compared using χ² test.

²Fisher’s exact test used where expected cell counts < 5.

Decompensation variables reflect prior or cumulative events and do not represent status at the time of LSM. CLD: Chronic liver disease; CP: Child-Pugh; HBV: Hepatitis B virus; HCV: Hepatitis C virus; INR: International normalized ratio; MASLD: Metabolic associated steatotic liver diseases; MetALD: Metabolic dysfunction and alcohol-associated liver disease; HCC: Hepatocellular carcinoma.

Table 2 Baseline characteristics of hepatocellular carcinoma patients, n (%)/median (interquartile range)

Characteristics	Patients with HCC, n = 133
Duration	2.6 (1.2-3.0)
Presentation at time of diagnosis of HCC
Screening/incidental	37 (28.7)
Jaundice	42 (31.6)
Hepatic encephalopathy	8 (6.1)
Bleed	4 (3.1)
Ascites	14 (10.5)
BCLC grading (stage)
0	19 (14.7)
A	21 (16.3)
B	29 (17.8)
C	23 (17.8)
D	37 (28.7)
Treatment received
Resection	6 (4.5)
Liver transplant	7 (5.4)
Microwave ablation	18 (13.5)
SBRT	11 (8.3)
TACE	19 (14.3)
Tyrosine kinase inhibitors	34 (25.6)
Immunotherapy	5 (3.8)
Palliative therapy	29 (21.8)

BCLC: Barcelona-Clinic Liver Cancer; HCC: Hepatocellular carcinoma; SBRT: Stereotactic body radiation therapy; TACE: Transarterial chemoembolization.

Table 3 Various liver stiffness measurement cut-off values for predicting risk of hepatocellular carcinoma in patients with cirrhosis with sensitivity, specificity, positive predictive value and negative predictive value, 95%CI

LSM cut-off in kPa	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)
30	100.0 (91.2-100.0)	19.3 (13.2-27.3)	29.4 (22.4-37.6)	100.0 (85.7-100.0)	39.6 (32.4-47.4)
35	97.5 (87.1-99.6)	46.2 (37.5-55.2)	37.9 (29.1-47.5)	98.2 (90.6-99.7)	59.1 (51.4-66.5)
40	97.5 (87.1-99.6)	52.1 (43.2-60.9)	40.6 (31.3–50.6)	98.4 (91.5–99.7)	63.5 (55.8-70.6)
45	95.0 (83.5-98.6)	67.2 (58.4-75.0)	49.4 (38.5-60.3)	97.6 (91.5-99.3)	74.2 (66.9-80.4)
47	95.0 (83.5-98.6)	76.5 (68.1-83.2)	57.6 (45.6-68.8)	97.8 (92.5-99.4)	81.1 (74.3-86.5)
50	77.5 (62.5-87.7)	82.4 (74.5-88.2)	59.6 (46.1-71.8)	91.6 (84.8-95.5)	81.1 (74.3-86.5)
55	57.5 (42.2-71.5)	86.6 (79.3-91.6)	59.0 (43.4-72.9)	85.8 (78.5-91.0)	79.2 (72.3-84.8)
60	42.5 (28.5-57.8)	91.6 (85.2-95.4)	63.0 (44.2-78.5)	82.6 (75.2-88.1)	79.2 (72.3-84.8)
65	32.5 (20.1-48.0)	95.8 (90.5-98.2)	72.2 (49.1-87.5)	80.9 (73.6-86.5)	79.9 (73.0-85.4)
70	20.0 (10.5-34.8)	97.5 (92.8-99.1)	72.7 (43.4-90.3)	78.4 (71.1-84.2)	78.0 (70.9-83.7)
75	7.5 (2.6-19.9)	100.0 (96.9-100.0)	100.0 (43.9-100.0)	76.3 (69.0-82.3)	76.7 (69.6-82.6)

LSM: Liver stiffness measurement; NPV: Negative predictive value; PPV: Predictive value.

Table 4 Univariate and multivariate logistic regression analysis for various variables for hepatocellular carcinoma risk

Variable	Univariate logistic regression		Multivariate logistic regression
	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
LSM per 1 kPa increase	1.12 (1.08-1.17)	0.0001	1.09 (1.05-1.13)	0.0001
INR	1.75 (1.10-2.79)	0.02	1.6 (0.95-2.57)	0.06
Platelet count per 10³/μL	0.98 (0.96-1.00)	0.06	0.99 (0.97-1.01)	0.09
Serum bilirubin (mg/dL)	1.35 (1.10-1.67)	0.004	1.28 (0.93-1.60)	0.08
AFP (ng/mL)	1.01 (0.99-1.02)	0.09	1.0 (0.98-1.02)	0.42

AFP: Alpha-fetoprotein; INR: International normalized ratio; LSM: Liver stiffness measurement; MELD: Model for end-stage liver disease; OR: Odds ratio.