Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2023; 29(14): 2188-2201
Published online Apr 14, 2023. doi: 10.3748/wjg.v29.i14.2188
Acoustic radiation force impulse predicts long-term outcomes in a large-scale cohort: High liver cancer, low comorbidity in hepatitis B virus
Jennifer Tai, Adam P Harrison, Hui-Ming Chen, Chiu-Yi Hsu, Tse-Hwa Hsu, Cheng-Jen Chen, Wen-Juei Jeng, Ming-Ling Chang, Le Lu, Dar-In Tai
Jennifer Tai, Tse-Hwa Hsu, Cheng-Jen Chen, Wen-Juei Jeng, Ming-Ling Chang, Dar-In Tai, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
Adam P Harrison, Radiomics Group, Q Bio, San Carlos, CA 94063, United States
Hui-Ming Chen, Chiu-Yi Hsu, Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
Le Lu, DAMO Academy, Alibaba Group, New York, NY 94085, United States
Author contributions: Tai DI contributed to study concept and design; Tai J, Chen HM, Hsu CY, Chen CJ, Jeng WJ, Chang ML, and Tai DI contributed to data acquisition; Tai J, Harrison AP, Chen HM, Hsu CY, Jeng WJ, Chang ML, and Tai DI contributed to data analysis and interpretation; Tai J, Harrison AP, and Tai DI contributed to drafting of the manuscript; Harrison AP, Jeng WJ, Chang ML, and Lu L contributed to critical review of the manuscript for important intellectual content; Tai J, Chen HM, and Hsu CY contributed to statistical analysis; Tai DI and Lu L contributed to obtaining funding; Chen HM and Hsu CY contributed to technical or material support; Tai DI contributed to study supervision.
Supported by the Chang Gung Memorial Hospital and PAII Inc. (a United States subsidiary company of Ping An Insurance Group), No. SMRPG3I0011.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Chang Gung Medical Foundation (Approval No. 201801283B0 and No. 202200758B0).
Informed consent statement: The Institutional Review Board of the Chang Gung Medical Foundation waived the requirement of informed consent statement for this retrospective cohort study.
Conflict-of-interest statement: There is no conflict of interest to disclose.
Data sharing statement: No additional data is available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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 NonCommercial (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:
Corresponding author: Dar-In Tai, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5 Fuxing Street, Guishan Dist, Taoyuan 33305, Taiwan.
Received: December 16, 2022
Peer-review started: December 16, 2022
First decision: January 11, 2023
Revised: January 15, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 14, 2023
Research background

Acoustic radiation force impulse is used to measure liver fibrosis and predict outcomes. The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus (HBV) than in other etiologies of chronic liver disease.

Research motivation

Whether there are differences in performance of acoustic radiation force impulse (ARFI) in long term outcome prediction among different etiologiesof chronic liver disease remains to be studied.

Research objectives

We collected a cohort of patients who received ARFI studies. After excluding unsuitable cases, 1962 patients were included as the indexed cases. They were classified into HBV, HCV, and non-HBV, non-HCV (NBNC) groups. We examined the differences in demographics, comorbidity, carcinogenesis, and mortality among these groups at and after enrollment.

Research methods

These indexed cases were linked to the hospital’s cancer registration and national mortality databases to obtain complete outcome data. The data at enrollment were analyzed for differences among three groups and logistic regression was performed to search for predictors associated with cancers. Cox regression analysis and area under the receiver operating characteristic curve (AUROC) were used to assess the performance of ARFI in predicting hepatocellular carcinoma (HCC) and mortality.

Research results

At enrollment, the HBV group showed more males (77.5%), a higher prevalence of pre-diagnosed HCC, and a lower prevalence of comorbidities than the other groups (P < 0.001). The HCV group was older and had a lower platelet count and higher ARFI score than the other groups (P < 0.001). The NBNC group showed a higher body mass index, platelet count, and prevalence of pre-diagnosed non-HCC cancers (P < 0.001), especially breast cancer, and a lower prevalence of cirrhosis. After enrollment, male gender, ARFI score, and HBV were independent predictors of HCC. The 5-year risk of HCC was 5.9% and 9.8% for those ARFI-graded with severe fibrosis and cirrhosis, respectively. ARFI alone had an AUROC of 0.742 for prediction of HCC in 5 years. AUROC increased to 0.828 after adding etiology, gender, age, and platelet score. No difference in mortality rate was noted among the groups.

Research conclusions

The HBV group showed a higher prevalence of HCC but a lower prevalence of comorbidity that made mortality similar among the groups. Those ARFI-graded as severe fibrosis or cirrhosis should receive regular surveillance.

Research perspectives

The immune tolerance is a hallmark of HBV which could be related to poor antigen presentation of human leukocyte antigen-DP and -DQ molecules in HBV surface antigen carriers. Whether such behavior is associated with a low prevalence of comorbidity requires future study.