Prognostic value of liver stiffness measurement in patients with hepatocellular carcinoma (HCC) treated by radiofrequency ablation: a meta-analysis

Figures & data

Table 1. The main characteristics of studies included for LSM.

ID	Country	Study design	Sample size	Etiology	Liver cirrhosis	Technique	Cutoff	Previous treatment	Survival analysis	Variable type	NOS
Lee et al. [14]	Korea	Retrospective	111	HBV 71 HCV 19 Non-B non-C 21	75 67.6%	TE	13.1 kpa	No 56 RFA 7 TACE 47 Others 1	OS/RFS	Categorical	6
Lee et al. [12]	Korea	Prospective	134	HBV 112 HCV 12 Alcoholic 6 Others 4	NA	2D-SWE	13.3 kpa	No 53 Resection 10 Ablation 12 TACE 33 Multiple 26	OS/RFS	Categorical	6
Yoon et al. [18] TE	Korea	Prospective	120	HBV 88 HCV 7 Non-B/non-C 27	90 75.0%	TE	14 kpa	No	RFS	Categorical	6
Yoon et al. [18] ARFI	Korea	Prospective	120	HBV 88 HCV 7 Non-B/non-C 27	90 75.0%	ARFI	1.6 m/s	No	RFS	Categorical	6
Lee et al. [13]	China	Prospective	173	HBV 81 HCV 57 Alcoholic 13	NA	ARFI	1.5 m/s	No	OS/RFS	Categorical	5
Xie and Yu [17]	China	Prospective	273	HBV 273	NA	2D-SWE	–	No	OS/RFS	Categorical	6
Kim et al. [11]	Korea	Retrospective	78	NA	NA	TE	–	No	RFS	Continuous	6
Lee et al. [15]	Korea	Retrospective	228	HBV 149 HCV 33 Alcoholic 35 Non-B/non-C 9 NAFLD 2	168 73.7%	TE	13 kpa	No	RFS	Continuous	6
Rekik et al. [16]	France	Prospective	159	HBV 20 HCV 69 Alcoholic 76 NASH 51	159 100%	TE	–	No	OS/RFS	Continuous	5

OS: overall survival; RFS: recurrence-free survival; NOS: Newcastle–Ottawa scale; TE: transient elastography; 2D-SWE: 2-dimensional shear wave elastography; ARFI: acoustic radio force impulse; HBV: hepatitis B; HCV: hepatitis C; NASH: nonalcoholic steatohepatitis; TACE: transarterial chemoembolization.

Figure 1. Flow chart of literature search and study selection. A total of 791 articles were initially retrieved. After carefully reviewed eight studies reporting liver stiffness measurement (LSM) were included in the analysis.

Figure 2. Forest plots of the relationship between LSM and survival outcomes in hepatocellular carcinoma patients treated with RFA in categorical group. A fixed-effect model was used to evaluate the impact of LSM on OS. The pooled result indicated that high LSM was associated with poor OS. LSM: liver stiffness measurement; HR: hazard ratio; CI: confidence interval.

Figure 3. Forest plots of the relationship between LSM and survival outcomes in hepatocellular carcinoma patients treated with RFA in categorical group. A random-effect model was used to evaluate the impact of LSM on RFS. The pooled result indicated that high LSM was associated with poor RFS. LSM: liver stiffness measurement; RFS: recurrence-free survival; HR: hazard ratio; CI: confidence interval; HR: hazard ratio.

Table 2. Results of subgroup analysis.

	RFS
	Association		Heterogeneity
Analysis	HR (95% CI)	p	I^2 (%)
Categorical group
Total	2.63 (1.63–4.22)	<.001	65.2
Country
Korea	2.85 (1.42–5.74)	<.001	78.6
China	2.18 (1.28–3.72)	.004	0
Technique
TE	3.36 (2.05–5.53)	<.001	0
2D-SWE	1.64 (0.81–3.32)	.017	42.6
AFRI	3.25 (1.19–8.85)	.021	76.2
Continuous group
Total	1.02 (1.01–1.04)	.003	72.1
Country
Korea	1.03 (1.02–1.04)	<.001	0
France	–	–	–

RFS: recurrence-free survival; TE: transient elastography; 2D-SWE: 2dimensional shear wave elastography; ARFI: acoustic radio force impulse.

Figure 4. Forest plots of the relationship between LSM and survival outcomes in hepatocellular carcinoma patients treated with RFA in continuous group. A random-effect model was used to evaluate the impact of LSM on RFS. The pooled result indicated that high LSM was associated with poor RFS. LSM: liver stiffness measurement; RFS: recurrence-free survival; HR: hazard ratio; CI: confidence interval; HR: hazard ratio.

Figure 5. Funnel plots for assessing publication bias in survival outcomes. The funnel plots of the association between LSM and RFS were basically symmetrical. LSM: liver stiffness measurement; RFS: recurrence-free survival.

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