Can Liver Ultrasound Elastography Predict the Risk of Hepatocellular Carcinoma Recurrence After Radiofrequency Ablation? A Systematic Review and Meta-Analysis

Abstract

Purpose The role of liver stiffness (LS) on ultrasound elastography in the prediction of hepatocellular carcinoma (HCC) recurrence after treatment with radiofrequency ablation (RFA) is still unclear. Our aim was to perform a systematic review and meta-analysis to assess whether LS can predict the recurrence of HCC after RFA.

Materials and Methods Medline via PubMed, Embase, Scopus, and Cochrane Library databases, and abstracts of international conference proceedings were searched up to June 30, 2020. Cohort studies were included if they assessed the association between LS values measured by ultrasound elastography before RFA and HCC recurrence.

Results 9 studies including 1373 patients with HCC treated by RFA, 643 of whom developed HCC recurrence, were identified. The mean value of LS before RFA was significantly higher in patients who developed HCC recurrence than in those who did not (weighted mean difference=11.98 kPa, 95%CI: 7.60–16.35, I2=63.8%). There was a significant positive association between LS value and HCC recurrence both at univariate (unadjusted HR=1.03, 95%CI: 1.00–1.07, I2=72.7%) and multivariate analysis (adjusted HR=1.03, 95%CI: 1.02–1.04, I2=0). Patients with LS value ≥13–14 kPa or >1.5 m/s have a higher risk of both HCC recurrence (unadjusted HR=2.18, 95%CI: 1.46–3.25, I2=49.7%; adjusted HR=2.41, 95%CI: 1.53–3.79, I2=0) and overall mortality (adjusted HR=4.38; 95%CI: 2.33–8.25, I2=0) in comparison with those with LS below these cutoffs.

Conclusion Liver ultrasound elastography appears to be a reliable tool to predict HCC recurrence and overall survival after RFA. This technique may be useful for the management of patients with HCC treated by RFA.

Zusammenfassung

Ziel Die Rolle der Lebersteifigkeit (LS) in der Ultraschall-Elastografie bei der Vorhersage eines Rezidivs des hepatozellulären Karzinoms (HCC) nach Behandlung mit Radiofrequenzablation (RFA) ist noch unklar. Unser Ziel war es, eine systematische Übersicht und Metaanalyse durchzuführen, um zu beurteilen, ob die LS ein Rezidiv des HCC nach RFA vorhersagen kann.

Material und Methoden Durchsucht wurden Medline über die Datenbanken PubMed, Embase, Scopus und Cochrane Library sowie Abstracts internationaler Konferenzberichte bis zum 30. Juni 2020. Kohortenstudien wurden eingeschlossen, wenn sie den Zusammenhang zwischen den mittels Ultraschall-Elastografie gemessenen LS-Werten vor RFA und dem HCC-Rezidiv untersuchten.

Ergebnisse Es wurden 9 Studien mit 1373 Patienten mit HCC, die mit RFA behandelt wurden, identifiziert, von denen 643 ein HCC-Rezidiv entwickelten. Der mittlere LS-Wert vor RFA war bei Patienten, die ein HCC-Rezidiv entwickelten, signifikant höher als bei denen, die kein Rezidiv entwickelten (gewichtete mittlere Differenz = 11,98 kPa, 95%-KI 7,60–16,35, I2=63,8%). Es bestand ein signifikanter positiver Zusammenhang zwischen dem LS-Wert und dem HCC-Rezidiv sowohl bei der univariaten Analyse (unbereinigte HR=1,03, 95%-KI 1,00–1,07, I2=72,7%) als auch bei der multivariaten Analyse (bereinigte HR=1,03, 95%-KI 1,02–1,04, I2=0). Patienten mit einem LS-Wert ≥13–14 kPa oder >1,5 m/s haben ein höheres Risiko sowohl für ein HCC-Rezidiv (unbereinigte HR=2,18, 95%-KI 1,46–3,25, I2=49,7%; bereinigte HR=2,41, 95%-KI 1,53–3,79, I2=0) als auch für die Gesamtmortalität (bereinigte HR=4,38; 95%-KI 2,33–8,25, I2=0) im Vergleich zu Patienten mit LS unterhalb dieser Grenzwerte.

Schlussfolgerung Die Ultraschall-Elastografie der Leber scheint eine zuverlässige Methode zur Vorhersage des HCC-Rezidivs und des Gesamtüberlebens nach RFA zu sein. Dieses Verfahren kann für das Management von Patienten mit HCC, die mit RFA behandelt wurden, nützlich sein.

Keywords

hepatocellular carcinoma - radiofrequency ablation - ultrasound elastography - liver stiffness measurement

Publication History

Received: 31 March 2021

Accepted after revision: 30 August 2021

Article published online:
10 November 2021

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