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

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.

To evaluate whether LSM by transient elastography (TE) is associated with the presence of HCC among patients with established cirrhosis.

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 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).

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.