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

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. 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.