Digestive Diseases and Sciences

, Volume 64, Issue 10, pp 3013–3019 | Cite as

Role of Liver Stiffness Measurement in Predicting HCC Occurrence in Direct-Acting Antivirals Setting: A Real-Life Experience

  • Luca RinaldiEmail author
  • Maria Guarino
  • Alessandro Perrella
  • Pia Clara Pafundi
  • Giovanna Valente
  • Luca Fontanella
  • Riccardo Nevola
  • Barbara Guerrera
  • Natalina Iuliano
  • Michele Imparato
  • Alessio Trabucco
  • Ferdinando Carlo Sasso
  • Filomena Morisco
  • Antonio Ascione
  • Guido Piai
  • Luigi Elio Adinolfi
Original Article



The aim of this study was to evaluate the relationship between the liver stiffness measurement and the risk of developing hepatocellular carcinoma (HCC) in HCV cirrhotic patients undergoing new direct-acting antivirals.


From April 2015 to April 2017, all consecutive HCV cirrhotic patients treated by direct-acting antivirals were enrolled. A liver stiffness measurement was computed at baseline, and an ultrasound evaluation was provided for all patients at baseline and every 6 months until 1 year after the stopping of the antiviral therapy. The diagnosis of HCC was performed according to international guidelines by imaging technique workup.


Two hundred and fifty-eight HCV patients with a diagnosis of cirrhosis were identified. The median liver stiffness was 25.5 kPa. Thirty-five patients developed HCC. Patients were divided into three groups, based on their liver stiffness: < 20 kPa (n = 72), between 20 and 30 kPa (n = 92) and > 30 kPa (n = 94). Compared to the < 20 kPa and 20–30 kPa groups, the > 30 kPa group showed a statistically significant increased risk of HCC (p = 0.019; HR 0.329; 95% CI 0.131–0.830). A ROC curve analysis to assess the overall predictive performance of liver stiffness measurement on the HCC risk was performed. The results allow us to identify a cutoff value of liver stiffness measurement equal to 27.8 kPa, which guarantees the highest sensitivity and specificity (respectively, 72% and 65%).


The data underline that the baseline liver stiffness measurement and ultrasound surveillance is a valuable tool for assessing the risk of HCC in cirrhotic patients undergoing the direct-acting antivirals treatment.


Transient elastography Direct-acting antiviral HCC HCV cirrhosis Liver stiffness 


Compliance with ethical standards

Conflict of interest

The authors declare that they have not any personal or financial conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Luca Rinaldi
    • 1
    Email author
  • Maria Guarino
    • 2
  • Alessandro Perrella
    • 3
  • Pia Clara Pafundi
    • 1
  • Giovanna Valente
    • 4
  • Luca Fontanella
    • 5
  • Riccardo Nevola
    • 1
  • Barbara Guerrera
    • 1
  • Natalina Iuliano
    • 1
  • Michele Imparato
    • 5
  • Alessio Trabucco
    • 1
  • Ferdinando Carlo Sasso
    • 1
  • Filomena Morisco
    • 2
  • Antonio Ascione
    • 5
  • Guido Piai
    • 4
  • Luigi Elio Adinolfi
    • 1
  1. 1.Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”NaplesItaly
  2. 2.Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NaplesItaly
  3. 3.VII Department of Infectious Diseases and ImmunologyOspedali dei Colli P. O. D. CotugnoNaplesItaly
  4. 4.Department of Medical SciencesA.O.R.N. S. Anna and S. SebastianoCasertaItaly
  5. 5.Department of Internal Medicine, Centre for Liver DiseaseBuon Consiglio Fatebenefratelli HospitalNaplesItaly

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