Role of transient elastography and controlled attenuation parameter measurements in predicting portal hypertension in Egyptian patients with hepatocellular carcinoma candidate for liver resection

Background and aim
Hepatic resection for hepatocellular carcinoma (HCC) is a main therapy for the treatment of surgical candidate patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit of long-term outcomes. We investigated the role of transient elastography and controlled attenuation parameter (CAP) in predicting portal hypertension in those patients, to assess if they could replace an invasive procedure [hepatic venous pressure gradient (HVPG)]. Moreover, their role in prediction of HCC recurrence after surgical resection was assessed.
Patients and methods
The study was performed at Ain Shams University hospitals, Tropical Medicine Department. A total of 30 patients with HCC, being candidate for surgical resection, were included in our study. We divided them into two groups according to the presence or absence of portal hypertension. Assessment of portal hypertension was done by laboratory markers, upper gastrointestinal endoscopy, and HVPG measurements. Transient elastography and CAP measurements were done for all patients. Correlations were done between transient elastography readings and CAP readings with other parameters of portal hypertension. Patients who underwent surgical resection were followed up for 6 months after liver resection to detect HCC recurrence.
Results
A positive correlation between transient elastography, CAP, and HVPG was found. Receiver operating characteristic curves of transient elastography, CAP, and a combination between transient elastography+platelet were drawn to differentiate between the two groups. The best cutoff point for transient elastography to detect significant portal hypertension was more than 18, with sensitivity of 93.75%, specificity of 100.0%, and area under the curve (AUC) of 99.8. Moreover, the cutoff point for CAP to detect significant portal hypertension was more than 217, with sensitivity of 87.5%, specificity of 64.29%, and AUC of 81.2%. However, the cutoff point of the platelet count was 166, with sensitivity of 100%, specificity of 86.67%, and AUC of 100%. The combination between transient elastography and platelets showed sensitivity of 87.5%, specificity of 100.0%, and AUC of 95.5%. Moreover, transient elastography showed a significant role in predicting early recurrence of HCC, with value of 0.011.
Conclusion
Transient elastography and CAP can be used as a useful tool in evaluating portal hypertension and also can be used in predicting early recurrence of HCC after surgery.