Background/Aims Although important, clinically significant liver fibrosis is often overlooked in the general population. We aimed to examine the prevalence of clinically significant liver fibrosis using noninvasive tests (NITs) in the general population.
Methods We collected data from four databases (MEDLINE, Embase, Cochrane Library, and KoreaMed) from inception to June 13, 2023. Original articles reporting the prevalence of clinically significant liver fibrosis in the general population were included. The Stata metaprop function was used to obtain the pooled prevalence of liver fibrosis with NITs in the general population.
Results We screened 6,429 articles and included 45 eligible studies that reported the prevalence of clinically significant liver fibrosis in the general population. The prevalence of advanced liver fibrosis, using the high probability cutoff of the fibrosis-4 (FIB-4) index, was 2.3% (95% confidence interval [CI], 1.2–3.7%). The prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, assessed using vibration-controlled transient elastography (VCTE) among the general population, was 7.3% (95% CI, 5.9–8.8%), 3.5% (95% CI, 2.7–4.5), and 1.2% (95% CI, 0.8–1.8%), respectively. Region-based subgroup analysis revealed that the highest prevalence of advanced fibrosis using the high probability cutoff of the FIB-4 index was observed in the American region. Furthermore, the American region exhibited the highest prevalence of significant liver fibrosis, advanced liver fibrosis, and liver cirrhosis, using VCTE.
Conclusions Previously undiagnosed clinically significant liver fibrosis is found in the general population through NITs. Future research is necessary to stratify the risk in the general population.
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Methods Using probe-based HBV capturing followed by next-generation sequencing technology, HBV integration was examined in 10 samples (seven tumors and three non-tumor tissues) from seven chronic carriers who developed HCC after HBsAg loss. Genomic locations and patterns of HBV integration were investigated.
Results HBV integration was observed in six patients (85.7%) and eight (80.0%) of 10 tested samples. HBV integration breakpoints were detected in all of the non-tumor (3/3, 100%) and five of the seven (71.4%) tumor samples, with an average number of breakpoints of 4.00 and 2.43, respectively. Despite the lower total number of tumoral integration breakpoints, HBV integration sites in the tumors were more enriched within the genic area. In contrast, non-tumor tissues more often showed intergenic integration. Regarding functions of the affected genes, tumoral genes with HBV integration were mostly associated with carcinogenesis. At enrollment, patients who did not remain under regular HCC surveillance after HBsAg seroclearance had a large HCC, while those on regular surveillance had a small HCC.
Conclusions The biological functions of HBV integration are almost comparable between HBsAg-positive and HBsAgserocleared HCCs, with continuing pro-oncogenic effects of HBV integration. Thus, ongoing HCC surveillance and clinical management should continue even after HBsAg seroclearance in patients with CHB.
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Background/Aims Surveillance for hepatocellular carcinoma (HCC) with ultrasound in high-risk populations is generally believed to improve opportunities for treatment. However, tumors are still missed due to various factors. This study explores success versus failure of HCC surveillance. Methods: This is a retrospective study of 1,125 HCC cases. Categories considered for successful detection were largest tumor ≤3.0 cm, single tumors ≤3.0 cm and ≤2.0 cm, and adherence to Milan criteria. Examined factors were age <60 years, gender, rural residence, body-mass index (BMI), hepatitis infection, smoking, diabetes, hyperlipidemia, cirrhosis, ascites, and Model for End-Stage Liver Disease <10. Results: HCC was found on surveillance in 257 patients with a mean tumor size of 3.17 cm; multiple tumors were seen in 28% of cases, bilateral tumors in 7.4%, and vascular invasion in 3.7%. Surveillance was successful in 61.5% of cases involving a largest tumor ≤3.0 cm, with BMI ≥35 negatively affecting detection (odds ratio [OR] 0.28, P=0.014) and cirrhosis positively affecting detection (OR 2.31, P=0.036). Ultrasound detected 19.1% of single tumors ≤2.0 cm with ascites improving the detection rate (OR 3.89, P=0.001). Finally, adherence to Milan criteria occurred in 75.1% of cases, revealing negative associations with diabetes (OR 0.48, P=0.044 and male gender (OR 0.49, P=0.08). Conclusions: Although surveillance is recommended for HCC, not all surveillance ultrasound are ideal. Tumor detection can depend on gender, BMI, diabetes, cirrhosis, and ascites and is achieved in 19.1–75% of cases depending on the definition of success. Closer follow-up or additional imaging might be necessary for some patient subgroups.
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A multi‐analyte cell‐free DNA–based blood test for early detection of hepatocellular carcinoma Nan Lin, Yongping Lin, Jianfeng Xu, Dan Liu, Diange Li, Hongyu Meng, Maxime A. Gallant, Naoto Kubota, Dhruvajyoti Roy, Jason S. Li, Emmanuel C. Gorospe, Morris Sherman, Robert G. Gish, Ghassan K. Abou‐Alfa, Mindie H. Nguyen, David J. Taggart, Richard A. V Hepatology Communications.2022; 6(7): 1753. CrossRef
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Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance Junghwan Lee, Su Bee Park, Soyoung Byun, Ha Il Kim, Do Young Kim PLOS ONE.2022; 17(9): e0274747. CrossRef
Current status of disparity in liver disease Tomoki Sempokuya, Josh Warner, Muaataz Azawi, Akane Nogimura, Linda L Wong World Journal of Hepatology.2022; 14(11): 1940. CrossRef
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Diagnostic Performance of Simulated Abbreviated MRI for Early-Stage Hepatocellular Carcinoma Screening: A Comparison to Conventional Dynamic Contrast-Enhanced MRI Eun Sol Lim, Sung Mo Kim, Sang Soo Shin, Suk Hee Heo, Jong Eun Lee, Yong Yeon Jeong Journal of the Korean Society of Radiology.2021; 82(5): 1218. CrossRef
A Systematic Review and Narrative Synthesis of Health Economic Evaluations of Hepatocellular Carcinoma Screening Strategies Anh Le Tuan Nguyen, Hoa Thi Thu Nguyen, Kwang Chien Yee, Andrew J. Palmer, Christopher Leigh Blizzard, Barbara de Graaff Value in Health.2021; 24(5): 733. CrossRef
The APAC Score: A Novel and Highly Performant Serological Tool for Early Diagnosis of Hepatocellular Carcinoma in Patients with Liver Cirrhosis Joeri Lambrecht, Mustafa Porsch-Özçürümez, Jan Best, Fabian Jost-Brinkmann, Christoph Roderburg, Münevver Demir, Frank Tacke, Raphael Mohr Journal of Clinical Medicine.2021; 10(15): 3392. CrossRef
Reply to: “Comment on – A multi-center study of entecavir vs. tenofovir on prognosis of treatment-naïve chronic hepatitis B in the Republic of Korea” Beom Kyung Kim Journal of Hepatology.2020; 72(1): 198. CrossRef
Only one-third of hepatocellular carcinoma cases are diagnosed via screening or surveillance: a systematic review and meta-analysis Changqing Zhao, Feng Xing, Yee Hui Yeo, Michelle Jin, Richard Le, Michael Le, Mingjuan Jin, Linda Henry, Ramsey Cheung, Mindie H. Nguyen European Journal of Gastroenterology & Hepatology.2020; 32(3): 406. CrossRef
GALAD Score Detects Early Hepatocellular Carcinoma in an International Cohort of Patients With Nonalcoholic Steatohepatitis Jan Best, Lars P. Bechmann, Jan-Peter Sowa, Svenja Sydor, Alexander Dechêne, Kristina Pflanz, Sotiria Bedreli, Clemens Schotten, Andreas Geier, Thomas Berg, Janett Fischer, Arndt Vogel, Heike Bantel, Arndt Weinmann, Jörn M. Schattenberg, Yvonne Huber, Hen Clinical Gastroenterology and Hepatology.2020; 18(3): 728. CrossRef
Tumor-associated autoantibodies in combination with alpha-fetoprotein for detection of early stage hepatocellular carcinoma Christopher Welberry, Isabel Macdonald, Jane McElveen, Celine Parsy-Kowalska, Jared Allen, Graham Healey, William Irving, Andrea Murray, Caroline Chapman, Vasilis Kosmoliaptsis PLOS ONE.2020; 15(5): e0232247. CrossRef
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Is hepatocellular carcinoma surveillance in high-risk populations effective? Kristeen Onyirioha, Sukul Mittal, Amit G Singal Hepatic Oncology.2020;[Epub] CrossRef
Imaging Modalities for Hepatocellular Carcinoma Surveillance: Expanding Horizons beyond Ultrasound Hyo Jung Park, So Yeon Kim Journal of Liver Cancer.2020; 20(2): 99. CrossRef
Abbreviated MRI for Hepatocellular Carcinoma Screening and Surveillance Julie Y. An, Miguel A. Peña, Guilherme M. Cunha, Michael T. Booker, Bachir Taouli, Takeshi Yokoo, Claude B. Sirlin, Kathryn J. Fowler RadioGraphics.2020; 40(7): 1916. CrossRef
Validation of US Liver Imaging Reporting and Data System Version 2017 in Patients at High Risk for Hepatocellular Carcinoma Jung Hee Son, Sang Hyun Choi, So Yeon Kim, Hye Young Jang, Jae Ho Byun, Hyung Jin Won, So Jung Lee, Young Suk Lim Radiology.2019; 292(2): 390. CrossRef
Failure of hepatocellular carcinoma surveillance: inadequate echogenic window and macronodular parenchyma as potential culprits Yeun-Yoon Kim, Chansik An, Do Young Kim, Khalid Suliman Aljoqiman, Jin-Young Choi, Myeong-Jin Kim Ultrasonography.2019; 38(4): 311. CrossRef
Longitudinal assessment of alpha-fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis Mi Na Kim, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Do Young Kim Scandinavian Journal of Gastroenterology.2019; 54(10): 1283. CrossRef
Risk factors for biopsy‐proven advanced non‐alcoholic fatty liver disease in the Veterans Health Administration Y. A. Patel, E. J. Gifford, L. M. Glass, R. McNeil, M. J. Turner, B. Han, D. Provenzale, S. S. Choi, C. A. Moylan, C. M. Hunt Alimentary Pharmacology & Therapeutics.2018; 47(2): 268. CrossRef
Diffusion-weighted MRI as a screening tool for hepatocellular carcinoma in cirrhotic livers: correlation with explant data—a pilot study M. M. McNamara, J. V. Thomas, L. F. Alexander, M. D. Little, D. N. Bolus, Yufeng E. Li, D. E. Morgan Abdominal Radiology.2018; 43(10): 2686. CrossRef
Treatment for occult hepatocellular carcinoma: does it offer survival advantages over symptom-driven treatment? Kwang Min Kim, Jiyu Kim, Dong Hyun Sinn, Hye Seung Kim, Kyunga Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik Scandinavian Journal of Gastroenterology.2018; 53(6): 727. CrossRef
Surveillance of hepatocellular carcinoma: is only ultrasound enough? Woo Kyoung Jeong Clinical and Molecular Hepatology.2017; 23(3): 222. CrossRef
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