Studio prospettico monocentrico per la valutazione del ruolo dell'elastometria epato-splenica come predittore di insorgenza di epatocarcinoma in pazienti con cirrosi epatica.

Background Hepatocellular carcinoma (HCC) is a further complication of portal hypertension (PH) in the natural history of liver cirrhosis. Recent experimental data correlate the hepatic venous pressure gradient (HVPG), a method both invasive and risky, with the risk of HCC. Recently, liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), using transient elastography (TE, Fibroscan®, Paris, France) have been proposed as non-invasive tools(NITs) for the evaluation of PH. To date, only data reporting the prognostic role of LSM for HCC development are available, while there are no data for SSM. Aim To evaluate the role of LSM and SSM as predictors of the onset of HCC in patients with liver cirrhosis. Methods We consecutively and prospectively enrolled patients with chronic advanced compensated liver disease referring to our Department without prior diagnosis of HCC between 2012 and 2016. We followed up patients for at least 12 months or until the study ending. We performed a univariate and multivariate analysis in order to evaluate the predictive role of NITs for the development of HCC. Results We prospectively enrolled 140 patients of whom 92 patients were suitable for the study. Among them, 21 patients developed HCC. Age (HR 1.076, p = 0.018, CI 1.026-1.128) and SSM (HR 1.035, p = 0.037, CI 1.002-1.068) were independent predictors of development of HCC. Conclusions In our population, the age and the spleen stiffness measurement (SSM) of the patient are the only predictors for the development of HCC, the latter correlated to the degree of severity of liver disease and portal hypertension, both involved in carcinogenesis.