Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2020; 26(24): 3326-3343
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3326
Non-invasive tests for the prediction of primary hepatocellular carcinoma
Giovanni Marasco, Antonio Colecchia, Giovanni Silva, Benedetta Rossini, Leonardo Henry Eusebi, Federico Ravaioli, Elton Dajti, Luigina Vanessa Alemanni, Luigi Colecchia, Matteo Renzulli, Rita Golfieri, Davide Festi
Giovanni Marasco, Giovanni Silva, Benedetta Rossini, Leonardo Henry Eusebi, Federico Ravaioli, Elton Dajti, Luigina Vanessa Alemanni, Luigi Colecchia, Davide Festi, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
Antonio Colecchia, Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona 37126, Italy
Matteo Renzulli, Rita Golfieri, Radiology Unit, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna 40138, Italy
Author contributions: Marasco G, Colecchia C and Festi D designed research; Silva G, Rossini B, Ravaioli F, Dajiti E, Alemanni LV, Colecchia G, Renzulli M and Golfieri R performed research; Marasco G, Colecchia C, Silva G and Festi D drafted the manuscript; Rossini B, Alemanni LV drafted the tables; Eusebi LH revised the English language; all authors revised and approved the final version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Giovanni Marasco, MD, PhD, Academic Fellow, Academic Research, Research Fellow, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, Bologna 40138, Italy. giovannimarasco89@gmail.com
Received: February 14, 2020
Peer-review started: February 14, 2020
First decision: March 24, 2020
Revised: April 8, 2020
Accepted: June 12, 2020
Article in press: June 12, 2020
Published online: June 28, 2020
Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world and it is one of the main complications of cirrhosis and portal hypertension. Even in the presence of a well-established follow-up protocol for cirrhotic patients, to date poor data are available on predictive markers for primary HCC occurrence in the setting of compensated advanced chronic liver disease patients (cACLD). The gold standard method to evaluate the prognosis of patients with cACLD, beyond liver fibrosis assessed with histology, is the measurement of the hepatic venous pressure gradient (HVPG). An HVPG ≥10 mmHg has been related to an increased risk of HCC in cACLD patients. However, these methods are burdened by additional costs and risks for patients and are mostly available only in referral centers. In the last decade increasing research has focused on the evaluation of several, simple, non-invasive tests (NITs) as predictors of HCC development. We reviewed the currently available literature on biochemical and ultrasound-based scores developed for the non-invasive evaluation of liver fibrosis and portal hypertension in predicting primary HCC. We found that the most reliable methods to assess HCC risk were the liver stiffness measurement, the aspartate aminotransferase to platelet ratio index score and the fibrosis-4 index. Other promising NITs need further investigations and validation for different liver disease aetiologies.

Keywords: Non-invasive test, Fibrosis-4 index, Hepatocellular carcinoma, Liver stiffness measurement, Spleen stiffness measurement, Albi

Core tip: Poor data are available for the prediction of hepatocellular carcinoma in patients with compensated advanced chronic liver disease. Nowadays there is an increasing need for non-invasive tests for stratifying the risk of hepatocellular carcinoma. The most reliable tests for this purpose are the liver stiffness measurement, the aspartate aminotransferase to platelet ratio index score and the fibrosis-4 index, which more accurately assess liver fibrosis. Further research is needed to validate these encouraging results and to address the role of additional non-invasive tests to better evaluate portal hypertension degree in different liver disease aetiologies.