Non-Invasive Test for Liver Disease Can Predict Liver Cancer
New Miller School research shows that liver elastography is an effective and non-invasive way of predicting the risk of liver cancer for patients treated for hepatitis C.
Even after successful antiviral treatment for chronic hepatitis C, some patients who have cirrhosis can also develop liver cancer.
New research from the University of Miami Miller School of Medicine published in the journal Clinical Gastroenterology and Hepatology shows that a widely available test, liver elastography (Fibroscan), is an effective and non-invasive way of predicting the risk of liver cancer in these patients.
The study is led by first author Binu V. John, M.D., M.P.H., associate professor and section chief of gastroenterology and hepatology at the Bruce W. Carter Department of Veterans Affairs Medical Center. Miller School faculty members Paul Martin, M.D., chief of the Division of Digestive Diseases, and Seth A. Spector, M.D., also contributed.
“Since millions of patients with hepatitis C and cirrhosis continue to be followed for liver cancer screening, we felt it would be useful to develop a non-invasive test to predict the risk of liver cancer and personalize liver cancer screening in these patients,” Dr. John said.
Approach to Liver Cancer Screening
For the study, Dr. John and his team used existing liver elastography data to assess the hardness or stiffness of the liver. Ultrasound waves provided the liver’s health status. The study looked for a correlation between increased liver stiffness measured in kilopascals (kPa) and an increase in liver cancer risk.
For a normal liver, the stiffness value should be below six kPa. Patients with cirrhosis have measurements between 12.5 and 75.5 kPa, according to the National Institutes of Health.
To create an effective screening tool, the team used data from the Department of Veterans Affairs database. More than 120,000 veterans with hepatitis C and cirrhosis were in the preliminary pool for the study. Natural language processing extracted variables from thousands of notes in the database and narrowed the final analysis group to 1,850 participants.
“Liver elastography is readily available in most hepatology clinics and can be done at the same time as a clinic visit,” Dr. John explained. “Currently, liver elastography is routinely performed in patients with cirrhosis to predict the risk of health and liver decompensation. This study has significant clinical application in that the same test can also guide clinicians on the need for liver cancer screening.”
Effective Outcomes in Liver Diseases
The study’s use of liver elastography proved a correlation between an increase in cancer risk and an increase in liver stiffness. Cancer risk increased 3% in the study patients with every one-point increase in liver stiffness.
The annual liver cancer risk was 2% among patients with stiffness less than 10 kPa and 2.5% for those in the 10- to 15-kPa range. Patients with measurements between 20 and 25 kPa had a 5% cancer chance. Patients with measurements of at least 25 kPa had a 5.4% risk of liver cancer.
“The annual risk of liver cancer was low in patients with liver stiffness less than five kPa and without diabetes mellitus,” Dr. John confirmed. “Patients in this range do not warrant screening for liver cancer, as these results will avoid unnecessary testing. This way, we can prioritize care for those at increased risk.” Now the research team plans to examine if the relationship between liver stiffness and liver cancer risk are also observed for other liver diseases. The team will look at metabolic dysfunction associated with steatotic liver disease, a condition that affects millions of Americans.