Abstract
Background & AimsThe fibrosis stage, which is evaluated by the distribution pattern of collagen fibers, is a major predictor for the development of hepatocellular carcinoma (HCC) for patients with hepatitis C. Meanwhile, the role of elastin fibers has not yet been elucidated. The present study was conducted to determine the significance of quantifying both collagen and elastin fibers.MethodsWe enrolled 189 consecutive patients with hepatitis C and advanced fibrosis. Using Elastica van Gieson-stained whole-slide images of pretreatment liver biopsies, collagen and elastin fibers were evaluated pixel by pixel (0.46 μm/pixel) using an automated computational method. Consequently, fiber amount and cumulative incidences of HCC within 3 years were analyzed.ResultsThere was a significant correlation between collagen and elastin fibers, whereas variation in elastin fiber was greater than in collagen fiber. Both collagen fiber (p = 0.008) and elastin fiber (p < 0.001) were significantly correlated with F stage. In total, 30 patients developed HCC during follow-up. Patients who have higher elastin fiber (p = 0.002) in addition to higher collagen fiber (p = 0.05) showed significantly higher incidences of HCC. With regard to elastin fiber, this difference remained significant in F3 patients. Furthermore, for patients with a higher collagen fiber amount, higher elastin was a significant predictor for HCC development (p = 0.02).ConclusionsComputational analysis is a novel technique for quantification of fibers with the added value of conventional staging. Elastin fiber is a predictor for the development of HCC independently of collagen fiber and F stage.
Highlights
For patients with chronic liver disease, the assessment of fibrosis stage is of great importance, because the progression to liver cirrhosis is a major prognostic factor [1]
There was a significant correlation between collagen and elastin fibers, whereas variation in elastin fiber was greater than in collagen fiber
For patients with a higher collagen fiber amount, higher elastin was a significant predictor for hepatocellular carcinoma (HCC) development (p = 0.02)
Summary
For patients with chronic liver disease, the assessment of fibrosis stage is of great importance, because the progression to liver cirrhosis is a major prognostic factor [1]. Liver fibrosis is mainly caused by chronic inflammation because of viral infection, autoimmunity, alcohol consumption, and drug induced liver injury. Liver-related complications, such as hepatocellular carcinoma, ascites, variceal bleeding, and hepatic encephalopathy, commonly occur. To assess the risk of such complications, multiple noninvasive methods have been studied; histological evaluation remains the golden standard for evaluating the stage of fibrosis. The fibrosis stage, which is evaluated by the distribution pattern of collagen fibers, is a major predictor for the development of hepatocellular carcinoma (HCC) for patients with hepatitis C. The present study was conducted to determine the significance of quantifying both collagen and elastin fibers
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