Antiviral treatment reduces, but does not eliminate, the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Predicting HCC risk in this population remains challenging. This study aimed to use dynamic changes in liver stiffness measurement (LSM) obtained using two-dimensional (2D) shear-wave elastography (SWE) to predict HCC in patients with non-cirrhotic and cirrhotic CHB who had well-controlled viremia. We retrospectively enrolled 303 patients with CHB (45 patients with cirrhosis) who had well-controlled viremia (hepatitis B virus DNA 8.1 kPa at least once), and sustained high LSM (all LSMs > 8.1 kPa). Among the 303 patients, 27 developed HCC. In the multivariable analysis, sustained high LSM in dynamic LSM changes (HR = 11.624, 95% CI: 4.241–31.861; P < 0.001; compared with sustained low LSM) and older age (HR = 1.046, 95% CI: 1.009–1.084; P = 0.013) independently predicted HCC. A novel model combining age and dynamic LSM changes achieved a C-index of 0.845 for internal validation, demonstrating reliable agreement between the predicted and observed probabilities of HCC development. The novel model showed better performance in non-cirrhotic patients with a C-index of 0.860, whereas the C-index was only 0.634 in cirrhotic patients. Dynamic LSM changes can predict HCC in patients with CHB who have well-controlled viremia, especially in non-cirrhotic patients.
Wang et al. (Mon,) studied this question.
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