Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2024; 30(10): 1450-1460
Published online Mar 14, 2024. doi: 10.3748/wjg.v30.i10.1450
Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication: A systematic review and meta-analysis
Giorgio Esposto, Paolo Santini, Linda Galasso, Irene Mignini, Maria Elena Ainora, Antonio Gasbarrini, Maria Assunta Zocco
Giorgio Esposto, Linda Galasso, Irene Mignini, Maria Elena Ainora, Maria Assunta Zocco, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Rome, Rome 00168, Italy
Paolo Santini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
Antonio Gasbarrini, Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Author contributions: Zocco MA, Ainora ME, Gasbarrini A designed the research; Esposto G, Santini P, Galasso L, Mignini I performed the research; Esposto G, Santini P contributed analytical tools; Esposto G, Santini P analyzed the data; Esposto G, Santini P, Galasso L, Zocco MA wrote the paper.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Assunta Zocco, MD, PhD, Researcher, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Rome, Largo gemelli 1, Rome 00168, Italy. mariaassunta.zocco@unicatt.it
Received: December 27, 2023
Peer-review started: December 27, 2023
First decision: January 5, 2024
Revised: January 13, 2024
Accepted: January 31, 2024
Article in press: January 31, 2024
Published online: March 14, 2024
Processing time: 78 Days and 0.9 Hours
Abstract
BACKGROUND

Direct-acting antiviral agents (DAAs) are highly effective treatment for chronic hepatitis C (CHC) with a significant rate of sustained virologic response (SVR). The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis progression. The assessment of fibrosis degree can be performed with transient elastography, magnetic resonance elastography or shear-wave elastography (SWE). Liver elastography could function as a predictor for hepatocellular carcinoma (HCC) in CHC patients treated with DAAs.

AIM

To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus (HCV).

METHODS

A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV clearance. In accordance with the study protocol, a qualitative and quantitative analysis of the evidence was planned.

RESULTS

At baseline and after 12 wk of follow-up, a trend was shown towards greater liver stiffness (LS) in those who go on to develop HCC compared to those who do not [baseline LS standardized mean difference (SMD): 1.15, 95% confidence interval (95%CI): 020-2.50; LS SMD after 12 wk: 0.83, 95%CI: 0.33-1.98]. The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source data. There was a statistically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not (0.64; 95%CI: 0.04-1.24).

CONCLUSION

SWE could be a promising tool for prediction of HCC occurrence in patients treated with DAAs. Further studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

Keywords: Shear-wave elastography; Hepatocellular carcinoma; Hepatitis C virus; Sustained virologic response

Core Tip: The role of shear wave-elastography (SWE) is still unclear in predicting hepatocellular carcinoma (HCC) after hepatitis C virus eradication. This is the first systematic review and meta-analysis that focuses on SWE as a predictor of HCC in sustained virologic response patients.