EASL肝癌峰会丨Abdel Ghani Atef教授：瞬时弹性成像技术助力肝癌早筛

本研究纳入1000例肝硬化患者。患者分为两组：I组为经超声及三期CT确诊的500例肝硬化合并HCC患者；Ⅱ组为经临床、实验室及超声检查排除HCC的500例肝硬化患者。排除标准包括病态肥胖、腹水、肝转移性病灶及超出米兰标准的HCC病例。所有患者均接受瞬时弹性成像检测。研究者对HCC患者进行肿瘤特征评估，采用Okuda、CLIP、VISUM及东京分期系统进行肿瘤分期。

HCC患者平均年龄57.3岁，显著高于非HCC肝硬化组（51.4岁），且男性占比达86%。HCC组肝硬度值显著高于单纯肝硬化组。当临界值设为30.5kPa时，瞬时弹性成像技术诊断HCC的敏感度为76%、特异性为87%、准确率达91.8%。该检测结果与HCC患者肿瘤大小、Child-Pugh分级、Okuda分期、CLIP分期及东京分期均呈显著正相关（ P 均＜0.001）。研究证实肝硬度升高与HCC风险相关。肝硬度在25-30 kPa时，发生HCC的概率达93%，需密切随访；肝硬度≥30 kPa的患者均确诊为HCC。

本研究表明，以30.5 kPa为临界值，瞬时弹性成像技术对肝硬化患者HCC早期检测具有重要价值。肝硬度≥30kPa的肝硬化患者高度提示HCC发生，而≥25kPa者属于HCC高危人群需加强监测。

Abdel Ghani Atef教授： 首先，我们将患者分为HCC组和无HCC的肝硬化组。通过统计学分析和瞬时弹性成像技术检测，我们最终确定30.5 kPa作为HCC检测的临界值。这一阈值完全基于统计学结果得出。值得注意的是，在不同病因（无论是病毒性肝炎还是代谢性肝病）患者中，该临界值并未表现出显著差异。

Oncology Frontier: How was the cutoff value of 30.5 kPa determined for early HCC detection, and should this threshold be adjusted for different patient populations such as those with viral hepatitis versus metabolic-associated liver disease?

Professor Abdel Ghani Atef: First of all, we divided our patients into two groups: one group with HCC and one group of cirrhotic patients without HCC. After conducting a statistical analysis and performing FibroScan on both groups, we identified a cutoff value of 30.5 kPa for HCC detection. This threshold was determined based on our statistical findings. Importantly, we did not observe any significant differences in this cutoff among patients with different etiologies, whether related to viral hepatitis or metabolic liver disease.

Abdel Ghani Atef教授： 我们发现肝硬度值在25-30 kPa区间的患者需要重点监测。对此类高危人群，我们建议每6个月进行瞬时弹性成像技术、超声和甲胎蛋白联合随访方案。这类患者发生HCC的风险较高，通过定期影像学检查和生物标志物评估，我们可以在早期阶段进行干预，从而改善患者预后。

Oncology Frontier: Your findings indicate that patients with liver stiffness above 25 kPa require close follow-up. What follow-up strategies do you recommend, and should they vary by disease etiology or geography?

Professor Abdel Ghani Atef: During our research, we observed that patients with liver stiffness values between 25 and 30 kPa required close monitoring. For these patients, we recommend a follow-up strategy that includes FibroScan, ultrasound, and alpha-fetoprotein testing every six months. These patients are at a high risk of developing HCC, and our goal is to ensure early detection and treatment. By implementing regular ultrasound and biomarker assessments, we can intervene at an early stage and improve patient outcomes.

Abdel Ghani Atef教授： 目前已有多种HCC早期筛查的无创检测手段。我们的研究表明，瞬时弹性成像技术通过30.5 kPa临界值可有效识别高危人群。但为提高诊断准确性，建议采用甲胎蛋白检测、影像学检查、瞬时弹性成像技术和GALAD评分相结合的多模态诊断方案。此外，国际多中心合作对验证标准化多模态模型至关重要，这将确保其在不同人群中的普适性和可靠性。

Oncology Frontier: How does FibroScan compare to other non-invasive diagnostic tools like FIB-4, GALAD score, and imaging techniques in terms of predictive accuracy for HCC? Could international collaborations help establish a standard multimodal diagnostic model?

Professor Abdel Ghani Atef: There are several non-invasive modalities available for early HCC detection. In our study, we found that FibroScan provides a reliable cutoff of 30.5 kPa for identifying high-risk patients. However, to achieve a more accurate diagnosis, we recommend a multimodal approach that includes alpha-fetoprotein testing, radiological imaging, FibroScan, and the GALAD score. By integrating multiple diagnostic tools, we can improve the precision of HCC detection. Additionally, international collaborations could play a crucial role in validating a standardized multimodal model, ensuring broader applicability and reliability across different populations.

Abdel Ghani Atef教授： 埃及和中国在这一领域的合作将极具价值。两国都有大量HCC高危风险的肝病患者。HCC作为高侵袭性肿瘤，早诊早治是改善预后的关键。如果两国联合开展大规模HCC筛查项目，不仅可以提升早期诊断率，更能优化治疗策略。双方在监测体系建设和早诊方案优化方面的经验交流，将为全球HCC防治作出重要贡献。

Oncology Frontier: Given the high burden of liver disease in Egypt and China, do you see potential for collaboration in large-scale HCC screening programs? What lessons can both regions share regarding surveillance limitations and early detection strategies?

Professor Abdel Ghani Atef: Yes, collaboration between Egypt and China in this field would be highly valuable. Both countries have a significant number of liver disease cases, and these patients are at increased risk of developing HCC. By working together, we can develop more effective early detection strategies. HCC is a highly aggressive tumor, and early treatment is essential for improving patient outcomes. Establishing large-scale screening programs in both countries would enhance early diagnosis and allow for better treatment planning. Through shared research and surveillance programs, Egypt and China can contribute significantly to the global fight against HCC.

Abdel Ghani Atef教授： 展望未来，我认为弹性成像技术仍是HCC检测的重要工具。由于HCC会导致肝硬度增加，弹性成像技术的进步将进一步推动早诊水平提升。磁共振弹性成像（MRE）虽然成本较高，但其高准确性展现出巨大潜力。随着技术进步，未来可能实现成本优化，使MRE成为更普及的HCC早期诊断工具。

Oncology Frontier: What are the key areas for future research to refine FibroScan’s predictive value for HCC? Do you anticipate advancements in elastography technology to enhance its clinical utility?

Professor Abdel Ghani Atef: Looking ahead, I believe that elastography will continue to be a valuable tool for HCC detection. Since HCC increases liver stiffness, advancements in elastography technology could further improve early detection. In particular, magnetic resonance elastography (MRE) shows great potential due to its high accuracy. However, it remains an expensive option compared to FibroScan. As technology advances, we may see improvements in affordability and accessibility, making MRE a more widely used tool for early HCC diagnosis.