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Impact of Fibroscan in the management of liver tumors

Abstract : Background: The major determinant of the results of surgical resection for liver tumors is the volume and quality of the future liver remnant. The hepatopathy of the non-tumoral liver not only limits the type of surgery but also the risk of recurrence in primary liver tumors. With respect to liver metastasis, pre-operative chemotherapy is the usual treatment strategy and the hepatotoxicity of prolonged chemotherapy is an important risk factor for post-operative morbi-mortality. In patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT), clinically significant portal hypertension (CSPH) is a risk for tumor progression and dropout of the waiting list for LT. Overall, degree of liver fibrosis and portal hypertension in the non-tumoral liver are important factors in the management of patients with liver tumors as they determine the prognosis of patients after hepatectomy. FibroScan®, which estimate the degree of liver fibrosis and steatosis, could utilized to evaluate the non-tumoral liver and predict the post-operative outcomes and the risk of dropout from the list of LT in HCC patients waiting for LT. Methods: Consecutive patients programmed to undergo hepatectomy or LT were included in the present study prospectively after an informed consent. Liver stiffness (LS) and controlled attenuation parameter (CAP) were measured pre-operatively by transient elastography using FibroScan® 502 Touch Standard device with M or XL probes. Results: LS-based nomograms that were developed and valided in this study were accurate to predict 90-day severe morbidity and 90-day mortality after hepatectomy for various hepatobiliary diseases. In patients with HCC undergoing hepatectomy, elevated LS ≥22 kPa was a risk factor for persistent hepatic decompensation beyond the 90-day post-operative period. Moreover, LS ≥30 kPa and CAP <240 dB/m were associated with poor oncological outcomes after resection and thus could be a surrogate biomarker of more aggressive HCC. The discriminatory ability of LS to diagnose advanced liver fibrosis (AUROC: 0.95) and cirrhosis (AUROC: 0.97) was validated in the present study. Further, CAP had a satisfactory performance to screen significant hepatic steatosis (S≥2) with AUROC of 0.70. A new LS-based model called HVPG10 score was developed and validated to diagnose CSPH. With a cut-off of 15, it was capable of accurately ruling out CSPH in >95% of the patients with chronic liver disease and would avoid further unnecessary investigations. Conclusion: Pre-operative evaluation of patients with transient elastography would enable surgeons to predict major complications and mortality after hepatectomy with LS-based nomograms. In patients with HCC, LS ≥30 kPa was an important risk factor of incomplete surgical resection, early recurrence after hepatectomy and for tumor progression and dropout while waiting for LT. Therefore, LT must be the primary treatment in HCC patients with LS ≥30 kPa.
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Submitted on : Monday, July 2, 2018 - 1:11:39 AM
Last modification on : Monday, October 17, 2022 - 1:40:13 PM
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  • HAL Id : tel-01827252, version 1

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Muthukumarassamy Rajakannu. Impact of Fibroscan in the management of liver tumors. Surgery. Université Paris Saclay (COmUE), 2017. English. ⟨NNT : 2017SACLS365⟩. ⟨tel-01827252⟩

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