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Liver stiffness measurement changes following hepatocellular carcinoma treatment with percutaneous microwave ablation or transarterial chemoembolization

a cohort study

Abdelaziz, Ashraf O.a; Abdelhalim, Hanana; Elsharkawy, Aishaa; Shousha, Hend I.a; Abdelmaksoud, Ahmed H.b; Soliman, Zeinab A.a; Seif, Mohamed I.a; Sayed, Dina B.c; Farouk, Mohamed H.d; Elbaz, Tamer M.a; Nabeel, Mohamed M.a

European Journal of Gastroenterology & Hepatology: June 2019 - Volume 31 - Issue 6 - p 685–691
doi: 10.1097/MEG.0000000000001343
Original Articles: Hepatology

Background Liver stiffness increases after the development of hepatocellular carcinoma (HCC). Transient elastography for liver stiffness measurement (LSM) using fibroscan is a simple noninvasive method of proven efficacy. This study aims to assess the changes in LSM following HCC treatment.

Patients and methods This study included 150 patients with hepatitis C virus related HCC attending the multidisciplinary HCC clinic, Kasr Al-Ainy Hospital between March 2014 and October 2015 who underwent either transarterial chemoembolization (TACE) or microwave ablation (MWA). Baseline LSM was carried out 3 and 6 months after treatment. The response rate was calculated according to the modified Response Evaluation Criteria in Solid Tumors criteria; overall survival and LSM changes were then compared between the two procedures.

Results MWA showed higher rates of complete ablation (77.4%) than did TACE (31.7%) (P=0.004). Increase in LSM 3 and 6 months after treatment was statistically significant in the TACE group (P<0.001) but not in the MWA group (P=0.4). Patients who showed complete ablation had statistically significant lower baseline LSM than those with incomplete ablation, and their 6 months increase in LSM was also significantly lower. Logistic regression revealed that with each unit increase in baseline stiffness, 3% reduction in the odds of complete ablation is expected, and this did not change after controlling for the type of treatment. Child–Pugh class, number, and size of HCCs were our independent prognostic factors by Cox proportional analysis.

Conclusion The increase in LSM is significant after TACE than after MWA. Moreover, lower pre-ablation LSM is a predictor of complete ablation.

aEndemic Medicine Department

bDiagnostic and Interventional Radiology Department, Faculty of Medicine, Cairo University

cImbaba Fever Hospital

dEmbaba General Hospital, Giza, Egypt

Correspondence to Hend I. Shousha, MD, Endemic Medicine and Hepatogastroenterology Department, Cairo University, Giza 11562, Egypt Tel: +20 100 573 8455; fax: +20 225 326 543; e-mail:

Received May 27, 2018

Accepted July 25, 2018

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