1Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
2Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
3Department of Gastroenterology and Hepatology, Soonchunhyang University College of Medicine, Bucheon, Korea
4Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
5Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
6Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
7Department of Internal Medicine, St. Vincent`s Hospital, The Catholic University of Korea, Suwon, Korea
8Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
9Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
© 2023 The Korean Liver Cancer Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of Interest
Do Seon Song, Young Chang and Jeong-Ju Yoo currently serve as editorial board members for J Liver Cancer, and they were not involved in the review process of this article. Otherwise, the authors have no conflicts of interest to disclose.
Ethics Statement
The study protocol was approved by the institutional review board (IRB) of each hospital (SCHBC 2019-09-009-001; date of registration: December 26, 2019) and conformed to the ethical guidelines of the World Medical Association Declaration of Helsinki. Each IRB waived the requirement for informed consent owing to the retrospective nature of the study.
Funding Statement
This study was supported by the Soonchunhyang University research fund.
Data Availability
The data presented in this study are available upon request from the corresponding authors.
Author Contribution
Conceptualization: SHY, SSK, JJY
Formal analysis: JJY
Investigation: SGK, JHK, HAL, YSS, YKJ, HJY, DSS, SHK, MYK, YHA, JH, YSK, YC, SWJ, JYJ
Writing–original draft: SHY, SSK, JJY
Writing–review & editing: SHY, JJY
Approval of final manuscript: all authors
Variable | Total (n=7,989) | ||
---|---|---|---|
Patient factor | |||
Sex | |||
Male | 4,531 (56.7) | ||
Female | 3,458 (43.3) | ||
Age (years) | 53.6±11.0 | ||
Etiology | |||
HBV | 5,992 (75.0) | ||
HCV | 899 (11.3) | ||
Alcohol | 362 (4.5) | ||
Others | 736 (9.2) | ||
Body mass index (kg/m2) | 24.1±3.3 | ||
Antiviral therapy (HBV, HCV patients only) | 4,637 (69.7) | ||
Presence of encephalopathy | 28 (0.4) | ||
Platelet (×103) | 188.1±75.8 | ||
AST (U/L) | 31.9±35.9 | ||
ALT (U/L) | 31.0±50.6 | ||
Total bilirubin (mg/dL) | 1.0±3.4 | ||
Albumin (mg/dL) | 4.4±0.4 | ||
PT INR | 1.1±0.8 | ||
Serum creatinine (mEq/dL) | 1.1±4.3 | ||
HBeAg positive, only in HBV | 1,363 (22.7) | ||
HBV DNA, only in HBV (×107 IU/mL) | 1.807±12.426 | ||
FIB-4 score | 2.2±2.8 | ||
<1.0 | 1,383 (23.8) | ||
1.0–2.5 | 3,176 (54.6) | ||
>2.5 | 1,259 (21.6) | ||
APRI | 0.6±1.0 | ||
Presence of fatty liver | 2,338 (29.3) | ||
Presence of liver cirrhosis | 2,299 (28.8) | ||
Presence of ascites | 93 (1.2) | ||
Child Pugh score (liver cirrhosis only) | 5.5±1.3 | ||
Child Pugh class (liver cirrhosis only) | |||
Class A | 1,685 (73.3) | ||
Class B | 576 (25.1) | ||
Class C | 38 (1.6) | ||
MELD score | 9.4±4.6 | ||
Transient elastography (kPa) | 8.8±10.5 | ||
Poor sonic window | |||
No | 7,479 (93.6) | ||
Yes | 510 (6.4) | ||
Skin to liver thickness (cm) | 1.8±0.5 | ||
Doctor factor | |||
Doctor department | |||
Gastroenterology | 4,919 (61.6) | ||
Radiology | 3,070 (38.4) | ||
Doctor experience (years) | 15.1±8.3 | ||
<15 | 4,310 (53.9) | ||
≥15 | 3,679 (46.1) | ||
Sonographic examination length (minutes) | 12.2±3.4 | ||
Machine factor, company | |||
GE Healthcare | 3,140 (39.3) | ||
PHILIPS | 691 (8.6) | ||
TOSHIBA | 3,625 (45.4) | ||
HITACHI | 237 (3.0) | ||
SIEMENS | 296 (3.7) |
Variable | Total (n=7,989) | HCC (-) (n=7,831) | HCC (+) in the 1st surveillance USG (n=23) | HCC (+) within 12 months since the 1st surveillance USG (n=23) | HCC (+) after 12 months since the 1st surveillance USG (n=112) | P-value | ||
---|---|---|---|---|---|---|---|---|
Patient factor | ||||||||
Sex | 0.040 | |||||||
Male | 4,531 (56.7) | 4,427 (56.5) | 17 (73.9) | 18 (78.3) | 69 (61.6) | |||
Female | 3,458 (43.3) | 3,404 (43.5) | 6 (26.1) | 5 (21.7) | 43 (38.4) | |||
Age (years) | 53.6±11.0 | 53.4±11.0 | 64.3±11.3 | 58.0±10.1 | 61.5±10.3 | <0.001 | ||
Etiology | 0.351 | |||||||
HBV | 5,992 (75.0) | 5,886 (75.2) | 17 (73.9) | 13 (56.5) | 76 (67.9) | |||
HCV | 899 (11.3) | 878 (11.2) | 3 (13.0) | 4 (17.4) | 14 (12.5) | |||
Alcohol | 362 (4.5) | 350 (4.5) | 1 (4.3) | 3 (13.0) | 8 (7.1) | |||
Others | 736 (9.2) | 717 (9.2) | 2 (8.7) | 3 (13.0) | 14 (12.5) | |||
Body mass index (kg/m2) | 24.1±3.3 | 24.1±3.3 | 24.7±4.2 | 24.4±4.1 | 24.8±3.4 | 0.173 | ||
Antiviral therapy | 4,637 (69.7) | 4,538 (69.5) | 13 (65.0) | 15 (88.2) | 71 (79.8) | 0.061 | ||
Encephalopathy | 28 (0.4) | 24 (0.3) | 1 (4.3) | 1 (4.3) | 2 (1.8) | <0.001 | ||
Platelet (×103) | 188.1±75.8 | 189.3±75.6 | 154.6±62.1 | 118.8±56.0 | 131.6±63.0 | <0.001 | ||
AST (U/L) | 31.9±35.9 | 31.7±36.0 | 39.0±27.4 | 37.4±17.4 | 39.5±33.2 | 0.083 | ||
ALT (U/L) | 31.0±50.6 | 30.9±51.0 | 33.2±21.0 | 29.6±17.2 | 31.9±22.9 | 0.992 | ||
Total bilirubin (mg/dL) | 1.0±3.4 | 1.0±3.4 | 1.1±0.6 | 1.6±1.5 | 1.1±0.6 | 0.831 | ||
Albumin (mg/dL) | 4.4±0.4 | 4.4±0.4 | 4.0±0.5 | 3.9±0.6 | 4.2±0.5 | <0.001 | ||
PT INR | 1.1±0.8 | 1.1±0.8 | 1.1±0.1 | 1.2±0.2 | 1.2±1.4 | 0.215 | ||
Serum creatinine (mEq/dL) | 1.1±4.3 | 1.1±4.3 | 1.2±1.1 | 1.0±0.2 | 0.9±0.5 | 0.980 | ||
HBeAg positive, only in chronic hepatitis B | 1,363 (28.0) | 1,345 (28.1) | 4 (28.6) | 3 (30.0) | 11 (17.2) | 0.286 | ||
HBV DNA, only in HBV (×107 IU/mL) | 1.807±12.426 | 1.836±12.529 | 0.134±0.428 | 3.9±13.6 | 0.193±1.441 | 0.660 | ||
FIB-4 score | 2.2±2.8 | 2.1±2.8 | 3.1±2.3 | 5.3±5.3 | 4.1±3.3 | <0.001 | ||
<1.0 | 1,383 (23.8) | 1,376 (24.1) | 2 (14.3) | 1 (5.3) | 4 (5.8) | |||
1.0–2.5 | 3,176 (54.6) | 3,144 (55.0) | 4 (28.6) | 5 (26.3) | 23 (33.3) | |||
>2.5 | 1,259 (21.6) | 1,196 (20.9) | 8 (57.1) | 13 (68.4) | 42 (60.9) | |||
APRI | 0.6±1.0 | 0.5±1.0 | 0.8±0.6 | 1.1±1.2 | 1.0±1.0 | <0.001 | ||
Presence of fatty liver | 2,338 (29.3) | 2,328 (29.7) | 3 (13.0) | 0 (0.0) | 7 (6.2) | <0.001 | ||
Presence of liver cirrhosis | 2,299 (28.8) | 2,181 (27.9) | 12 (52.2) | 18 (78.3) | 88 (78.6) | <0.001 | ||
Presence of ascites | 93 (1.2) | 87 (1.1) | 0 (0.0) | 2 (8.7) | 4 (3.6) | 0.001 | ||
Child Pugh score | 5.5±1.3 | 5.5±1.3 | 5.6±1.4 | 6.0±1.6 | 5.7±1.3 | 0.303 | ||
Child Pugh class | 0.098 | |||||||
Class A | 3,986 (86.7) | 3,867 (86.7) | 18 (90.0) | 16 (76.2) | 85 (84.2) | |||
Class B | 576 (12.5) | 556 (12.5) | 1 (5.0) | 4 (19.0) | 15 (14.9) | |||
Class C | 38 (0.8) | 35 (0.8) | 1 (5.0) | 1 (4.8) | 1 (1.0) | |||
MELD score | 9.4±4.6 | 9.4±4.6 | 9.7±3.4 | 11.0±5.2 | 9.9±5.0 | 0.268 | ||
Transient elastography (kPa) | 8.8±10.5 | 8.7±10.2 | 7.2±0.7 | 18.6±14.4 | 20.7±18.9 | <0.001 | ||
Poor sonic window | 0.096 | |||||||
No | 7,479 (93.6) | 7,331 (93.6) | 21 (91.3) | 19 (82.6) | 108 (96.4) | |||
Yes | 510 (6.4) | 500 (6.4) | 2 (8.7) | 4 (17.4) | 4 (3.6) | |||
Skin to liver thickness (cm) | 1.8±0.5 | 1.8±0.5 | 1.9±0.5 | 1.8±0.4 | 1.8±0.5 | 0.219 | ||
Doctor factor | ||||||||
Doctor department | 0.273 | |||||||
Gastroenterology | 4,919 (61.6) | 4,827 (61.6) | 14 (60.9) | 17 (73.9) | 61 (54.5) | |||
Radiology | 3,070 (38.4) | 3,004 (38.4) | 9 (39.1) | 6 (26.1) | 51 (45.5) | |||
Doctor experience (years) | 15.1±8.3 | 15.2±8.3 | 14.5±4.2 | 18.4±6.2 | 13.6±7.4 | 0.051 | ||
<15 | 4,310 (53.9) | 4,217 (53.9) | 11 (47.8) | 6 (26.1) | 76 (67.9) | |||
≥15 | 3,679 (46.1) | 3,614 (46.1) | 12 (52.2) | 17 (73.9) | 36 (32.1) | |||
Sonographic examination length (minutes) | 12.2±3.4 | 12.2±3.4 | 13.4±3.0 | 13.8±3.7 | 12.2±2.8 | 0.055 | ||
Machine factor, company | 0.051 | |||||||
GE Healthcare | 3,140 (39.3) | 3,086 (39.4) | 9 (39.1) | 15 (65.2) | 30 (26.8) | |||
PHILIPS | 691 (8.6) | 674 (8.6) | 2 (8.7) | 0 (0.0) | 15 (13.4) | |||
TOSHIBA | 3,625 (45.4) | 3,552 (45.4) | 9 (39.1) | 6 (26.1) | 58 (51.8) | |||
HITACHI | 237 (3.0) | 230 (2.9) | 1 (4.3) | 2 (8.7) | 4 (3.6) | |||
SIEMENS | 296 (3.7) | 289 (3.7) | 2 (8.7) | 0 (0.0) | 5 (4.5) |
Variable | Total (n=7,989) | HCC (-) (n=7,831) | HCC (+) (n=158) | P-value | ||
---|---|---|---|---|---|---|
Patient factor | ||||||
Sex | 0.024 | |||||
Male | 4,531 (56.7) | 4,427 (56.5) | 104 (65.8) | |||
Female | 3,458 (43.3) | 3,404 (43.5) | 54 (34.2) | |||
Age (years) | 53.6±11.0 | 53.4±11.0 | 61.4±10.5 | <0.001 | ||
Etiology | 0.083 | |||||
HBV | 5,992 (75.0) | 5,886 (75.2) | 106 (67.1) | |||
HCV | 899 (11.3) | 878 (11.2) | 21 (13.3) | |||
Alcohol | 362 (4.5) | 350 (4.5) | 12 (7.6) | |||
Others | 736 (9.2) | 717 (9.2) | 19 (12.0) | |||
Body mass index (kg/m2) | 24.1±3.3 | 24.1±3.3 | 24.8±3.6 | 0.028 | ||
Antiviral therapy | 4,637 (69.7) | 4,538 (69.5) | 99 (78.6) | 0.036 | ||
Encephalopathy | 28 (0.4) | 24 (0.3) | 4 (2.5) | <0.001 | ||
Platelet (×103) | 188.1±75.8 | 189.3±75.6 | 133.0±62.3 | <0.001 | ||
AST (U/L) | 31.9±35.9 | 31.7±36.0 | 39.1±30.4 | 0.003 | ||
ALT (U/L) | 31.0±50.6 | 30.9±51.0 | 31.7±21.8 | 0.669 | ||
Total bilirubin (mg/dL) | 1.0±3.4 | 1.0±3.4 | 1.2±0.8 | 0.009 | ||
Albumin (mg/dL) | 4.4±0.4 | 4.4±0.4 | 4.1±0.5 | <0.001 | ||
PT INR | 1.1±0.8 | 1.1±0.8 | 1.2±1.2 | 0.172 | ||
Serum creatinine (mEq/dL) | 1.1±4.3 | 1.1 ± 4.3 | 1.0 ± 0.6 | 0.091 | ||
HBeAg positive, only in chronic hepatitis B | 1,363 (28.0) | 1,345 (28.1) | 18 (20.5) | 0.141 | ||
HBV DNA, only in HBV (×107 IU/mL) | 1.807±12.426 | 1.836±12.529 | 0.158±1.231 | <0.001 | ||
FIB-4 score | 2.2±2.8 | 2.1±2.8 | 4.2±3.7 | <0.001 | ||
<1.0 | 1,383 (23.8) | 1,376 (24.1) | 7 (6.9) | |||
1.0–2.5 | 3,176 (54.6) | 3,144 (55.0) | 32 (31.4) | |||
>2.5 | 1,259 (21.6) | 1,196 (20.9) | 63 (61.8) | |||
APRI | 0.6±1.0 | 0.5±1.0 | 1.0±1.0 | <0.001 | ||
Presence of fatty liver | 2,338 (29.3) | 2,328 (29.7) | 10 (6.3) | <0.001 | ||
Presence of liver cirrhosis | 2,299 (28.8) | 2,181 (27.9) | 118 (74.7) | <0.001 | ||
Presence of ascites | 93 (1.2) | 87 (1.1) | 6 (3.8) | 0.006 | ||
Child Pugh score | 5.5±1.3 | 5.5±1.3 | 5.7±1.3 | 0.132 | ||
Child Pugh class | 0.186 | |||||
Class A | 3,986 (86.7) | 3,867 (86.7) | 119 (83.8) | |||
Class B | 576 (12.5) | 556 (12.5) | 20 (14.1) | |||
Class C | 38 (0.8) | 35 (0.8) | 3 (2.1) | |||
MELD score | 9.4±4.6 | 9.4±4.6 | 10.0±4.8 | 0.102 | ||
Transient elastography (kPa) | 8.8±10.5 | 8.7±10.2 | 19.7±17.7 | <0.001 | ||
Poor sonic window | 1.000 | |||||
No | 7,479 (93.6) | 7,331 (93.6) | 148 (93.7) | |||
Yes | 510 (6.4) | 500 (6.4) | 10 (6.3) | |||
Skin to liver thickness (cm) | 1.8±0.5 | 1.8±0.5 | 1.9±0.5 | 0.043 | ||
Doctor factor | ||||||
Doctor department | 0.429 | |||||
Gastroenterology | 4,919 (61.6) | 4,827 (61.6) | 92 (58.2) | |||
Radiology | 3,070 (38.4) | 3,004 (38.4) | 66 (41.8) | |||
Doctor experience (years) | 15.1±8.3 | 15.2±8.3 | 14.4±7.0 | 0.186 | ||
<15 | 4,310 (53.9) | 4,217 (53.9) | 93 (58.9) | 0.242 | ||
≥15 | 3,679 (46.1) | 3,614 (46.1) | 65 (41.1) | |||
Sonographic examination length (minutes) | 12.2±3.4 | 12.2±3.4 | 12.6±3.0 | 0.104 | ||
Machine factor, company | 0.505 | |||||
GE Healthcare | 3,140 (39.3) | 3,086 (39.4) | 54 (34.2) | |||
PHILIPS | 691 (8.6) | 674 (8.6) | 17 (10.8) | |||
TOSHIBA | 3,625 (45.4) | 3,552 (45.4) | 73 (46.2) | |||
HITACHI | 237 (3.0) | 230 (2.9) | 7 (4.4) | |||
SIEMENS | 296 (3.7) | 289 (3.7) | 7 (4.4) |
Variable | Total (n=158) | HCC (+) in the 1st surveillance USG (n=23) | HCC (+) within 12 months since the 1st surveillance USG (n=23) | HCC (+) after 12 months since the 1st surveillance USG (n=112) | P-value | |
---|---|---|---|---|---|---|
Tumor location | 0.915 | |||||
Right | 49 (62.8) | 14 (60.9) | 14 (66.7) | 21 (61.8) | ||
Left | 21 (26.9) | 6 (26.1) | 6 (28.6) | 9 (26.5) | ||
Both | 8 (10.3) | 3 (13.0) | 1 (4.8) | 4 (11.8) | ||
Tumor size (cm) | 2.4±2.0 | 3.0±3.6 | 2.2±1.7 | 2.4±1.6 | 0.373 | |
Tumor echogenicity | 0.844 | |||||
Hypoechoic | 94 (75.8) | 17 (73.9) | 19 (86.4) | 58 (73.4) | ||
Isoechoic | 12 (9.7) | 2 (8.7) | 2 (9.1) | 8 (10.1) | ||
Hyperechoic | 17 (13.7) | 4 (17.4) | 1 (4.5) | 12 (15.2) | ||
Non-visualization | 1 (0.8) | 0 (0.0) | 0 (0.0) | 1 (1.3) | ||
Tumor type | 0.531 | |||||
Nodular | 154 (98.1) | 23 (100.0) | 23 (100.0) | 108 (97.3) | ||
Infiltrative | 3 (1.9) | 0 (0.0) | 0 (0.0) | 3 (2.7) | ||
BCLC stage | 0.147 | |||||
A | 134 (87.0) | 18 (78.3) | 20 (87.0) | 96 (88.9) | ||
B | 11 (7.1) | 2 (8.7) | 1 (4.3) | 8 (7.4) | ||
C | 8 (5.2) | 3 (13.0) | 1 (4.3) | 4 (3.7) | ||
D | 1 (0.6) | 0 (0.0) | 1 (4.3) | 0 (0.0) | ||
T stage | 0.178 | |||||
T1 | 92 (59.7) | 10 (43.5) | 18 (78.3) | 64 (59.3) | ||
T2 | 49 (31.8) | 10 (43.5) | 3 (13.0) | 36 (33.3) | ||
T3 | 10 (6.5) | 3 (13.0) | 1 (4.3) | 6 (5.6) | ||
T4 | 3 (1.9) | 0 (0.0) | 1 (4.3) | 2 (1.9) | ||
N stage | 0.057 | |||||
N0 | 153 (99.4) | 23 (100.0) | 22 (95.7) | 108 (100.0) | ||
N1 | 1 (0.6) | 0 (0.0) | 1 (4.3) | 0 (0.0) | ||
M stage | 0.561 | |||||
M0 | 151 (98.1) | 22 (95.7) | 23 (100.0) | 106 (98.1) | ||
M1 | 3 (1.9) | 1 (4.3) | 0 (0.0) | 2 (1.9) |
Values are presented as number (%) or mean±standard deviation. FIB-4, fibrosis-4 score; APRI, AST to platelet ratio index; MELD: model for end-stage liver disease.
Values are presented as number (%) or mean±standard deviation. HCC, hepatocellular carcinoma; USG, ultrasound.
Values are presented as number (%) or mean±standard deviation. HCC, hepatocellular carcinoma; USG, ultrasound.
Values are presented as number (%) or mean±standard deviation. HCC, hepatocellular carcinoma; USG, ultrasound; BCLC, Barcelona Clinic Liver Cancer.