Role of Transient Elastography and Cotrolled Attenuation Parameter (CAP) Measurements in Predicting Portal Hypertension in Egyptian patients with Hepatocellular Carcinoma (HCC) Candidate for Liver Resection

Abstract

Background and aim: Hepatic resection for HCC is a main therapy for treatment in surgically candidate patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes. We investigated the role of Transient Elastography and CAP in predicting portal hypertension in those patients. So, if it could replace the invasive procedure (hepatic venous pressure gradient). Also, their role in prediction of HCC recurrence after surgical resection. Materials and Methods: The study was performed at Ain Shams University hospitals,tropical medicine department. Thirty patients with HCC; candidate for surgical resection; were included in our study.We divided them into two groups according to 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 was done for all patients. Correlations was done between Transient elastography readings and CAP readings with other parameters of portal hypertension. Patients underwent surgical resection were followed up for 6 months post liver resection to detect HCC recurrence. Results: Positive correlation between Transient Elastography, CAP and HVPG was found, ROC curve for transient Elastography, CAP and combination between transient Elastography + platelet to differentiate between the two groups, the best cut off point for Transient Elastography to detect significant Portal hypertension was > 18 with sensitivity of 93.75%, specificity of 100.0% and AUC of 99.8. Also the cut off point for CAP to detect significant Portal hypertension was was > 217 with sensitivity of 87.5%, specificity of 64.29% and AUC of 81.2%. While the cutoff point of the platelets 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%., also Transient Elastography And not CAP showed significant role in predicting early recurrence of HCC with P value of 0.011. Conclusion: Transient Elastography can be used as a useful tool in evaluating portal hypertension, also can be used in predicting early recurrence of HCC post-surgery.