Hepatocellular carcinoma is a major health problem especially in Egypt, where HCV appears to play a major role in the progression of chronic liver disease to HCC.
Radiofrequency ablation achieves a satisfactory local response rate, with more than 80% complete ablation in most studies, despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA.
The percentage of males in this study (66.7%) was higher than that of females (33.3%) with male to female ratio 2:1. An Egyptian study by Shaker et al [8] performed on 1313 patients with HCC revealed that the male to female ratio was 3.7:1.
Also, Hetta et al. [9] and Liu et al. [10] describe the male predominance of 81.9% and 92.5%, respectively.
High male to female liver cancer incidence rate ratios in some countries may reflect increased exposure of known risk factors amongst men. In Egypt, for example, the primary risk factor for liver cancer, hepatitis C viral infection, was widely transmitted by inoculations to control schistosomiasis, which was a disease more common amongst Egyptian men particularly those in rural areas who acquire it occupationally as farmworkers.
In this study, the age of patients ranged from 40 to 75 years with mean ± SD 57.52±7.09 years. This finding is close to Hussein et al. [11], who reported that the age of patients with HCC was 40–77 years with a mean of 56 ± 8.15 years.
In another Egyptian study by Shaker et al. [8], they found that the most frequent age group affected by HCC was between 51 and 60 years (45.7%), followed by the group between 41 and 50 years (24.4%). Also Hetta et al. [9] reported the mean age of HCC was 57 ± 4.6 years.
Relatively younger age in the Egyptian patients can be explained by the high prevalence of HCV among Egyptians and the occurrence of the infection at a young age.
In the current study, it was found that there was a significant negative correlation between LS measurement by TE and de novo recurrence of HCC with the mean of LS in patients with a complete response was (17.19 ± 3.32 kPa) and the mean of LS in patients with de novo recurrence was 36 .94 ± 5.93 kPa), with the best cutoff value of LS to predict de novo HCC recurrence after RFA a value of (> 24.65 kPa).
Conti et al. [12] reported that HCC recurrence more significantly recognized in the patients with LSM values over 21.5 kPa before DAA therapy.
Different results were described by Lee et al. [7] who adopted a LS cutoff value of 13.0 kPa to determine the high-risk group for recurrence.
Also Jung et al. 2012 [13] found that HCC patients with preoperative LS values more than13.4 kappa experienced a higher incidence of HCC recurrence after curative resection than did their counterparts.
As regards the differences in the cutoff value, this phenomenon can be explained in several ways. First, in the different etiologies of CLD in the studies population, we avoided this obstacle by excluding other etiologies rather than HCV in our sample and also the duration of the follow-up, with a higher possibility of recurrence with a long duration of follow-up even with low LS.
In the present study, we found that the LS was significantly associated with the prediction of hepatic decompensation after RF. The LS mean in patients without any manifestation of hepatic decompensation after RF was 17.3 kPa, patients complicated by with ascites only their LS mean was (23kPa), while those who were complicated by both ascites and jaundice during the period of follow-up was (38.5kPa) (p value <0.001 ).
Also Kang et al. [14] suggested that patients with higher LS values (13–18 and ≥ 18 kPa) had significantly higher risks of developing hepatic decompensation after RF compared to those with lower values (< 13 kPa) (HR = 4.547, P = 0.044 and HR = 12.446, P < 0.001, respectively).
A prospective study by Robic et al. [15] demonstrated that a preoperative LS > 21.1 kPa proved as effective as hepatic venous pressure gradient measurements to predict the clinical decompensation and liver-related events (ascites, variceal bleeding, HCC, HE, and death) after curative resection.
Two studies also looked at the evolution of liver stiffness values over time (Corpechot et al. [16], Vergniol et al. [17]) and found that patients with increasing liver stiffness (1–1.5 kPa per year) were a higher risk of developing complications, with one study estimating a 10-fold increase in complications (Corpechot et al. [16]).
In the present study, we found that the LS at cutoff value >42 .75 (p value = 0.031) and splenomegaly above 12.93 cm (p value <0.021) were significantly associated with the prediction of the 1-year mortality after RFA.
Lee et al. [7] founded that on univariate analysis, total bilirubin, spleen size, and LS value 13.0 kPa significantly predicted overall survival after RFA (all p value=0.05).
Pang et al. [18] found that among 2052 patients (with median age 51 years, 65% with hepatitis B or C), 87 patients (4.2%) died or developed a hepatic complication during a median follow-up period of 15.6 months (interquartile range, 11.0–23.5 months). Patients with complications had higher median liver stiffness than those without complications (13.5 vs. 6.0 kPa; P<0.00005). The 2-year incidence rates of death or hepatic complications were 2.6%, 9%, 19%, and 34% in patients with liver stiffness <10, 10–19.9, 20–39.9, and ≥40 kPa, respectively (p<0.00005)
In our study, it was found that there was no statistically significant correlation between FIB4 index, CDS, and API and de novo recurrence of HCC.
That phenomenon was also observed in a study by Suh et al. [19], suggesting that FIB-4 has the limited capability in differentiating the risk of HCC development in contrast to LS.
Also Kim et al. [20] LS reported that TE showed significantly greater prognostic performance than FIB-4 in predicting the development of HBV-related HCC. The combined use of LS and FIB-4 did not provide additional benefit compared with the use of LS alone.
Seo et al. [5] found that FIB-4 was not significantly correlated with Intrahepatic distant recurrence after RFA of hepatitis B-related HCC in contrast to CDS and API which had a significant correlation with intrahepatic distant recurrence with (p values 0.010 and 0.004), respectively.
The current study shows the correlation between baseline FIB4 score and the occurrence of hepatic decompensation after 1 year of intervention. The mean of FIB4 score in patients complicated by ascites and jaundice was 6.05 ± 4.71 (p value 0.05).
Butt et al. [21] concluded that FIB-4 was superior to the Child-Pugh and MELD scores for prediction of incident hepatic decompensation and hepatocellular carcinoma events among chronic HCV-infected persons. At a FIB-4 cutoff score of three, less than 1% of chronic HCV-infected patients developed hepatic decompensation or hepatocellular carcinoma.
