We believe that the close correlation between cLC and LSM lessened the influence of

cLC in the multivariate analysis, suggesting that LSM may be a stronger predictor of HCC than cLC. When we divided our study population into five groups using the stratified LSM, the proportion of patients with cLC and HCC development increased significantly in the groups with high LSMs. Furthermore, the stratified LSM was independently associated with HCC development in our study. These results indicate find more that a correlation between high LSM and HBV-related HCC development remains significant, even if HBV-related HCC can develop from a noncirrhotic background. However, the hazard ratio of HCC development in our patients with CHB was lower than that reported for those with CHC.13 Indeed, the hazard ratio for HCC development was 45.5 in patients who had CHC with LSM value >25 kPa, whereas it was only 6.6 in patients having CHB with LSM value >23 kPa in our study. The hazard ratio for HCC development in our patients may be reduced by HCC cases arising Akt inhibitor in a noncirrhotic background. However, because liver cirrhosis defined by LSM has been identified

as a strong independent risk factor for HBV-related HCC development as in HCV-related HCC,4, 25 we cautiously suggest that LSM can be used as a predictor of HCC development in both HBV and HCV-related chronic liver disease. In addition, because 8 kPa has

been reported as a cutoff value for significant fibrosis (stage F2 or higher),22, 34 our results suggest that patients with significant fibrosis are also at a higher risk of HCC development. When the incidence of HCC was compared among groups classified using the LSM and clinical criteria of liver cirrhosis, the incidence of HCC did not differ significantly between patients with LSM ≤13 kPa and cLC and those with LSM ≤13 kPa and without cLC (Fig. 4). However, the mean LSM in patients with LSM ≤13 kPa and cLC was significantly MCE公司 higher than that of patients with LSM ≤13 kPa and without cLC (9.5 versus 6.9 kPa; P < 0.001). When compared with patients with LSM >13 kPa and cLC, the proportions of HBeAg positivity (22.2% [n = 10] versus 47.0% [n = 62]; P = 0.004) and detectable HBV DNA (28.9% [n = 13] versus 43.2% [n = 57]; P = 0.048) were significantly lower in patients with LSM ≤13 kPa and cLC. Furthermore, most patients (n = 35, 77.8%) had previous or ongoing use of an antiviral agent. Therefore, the high proportion of antiviral treatment, lower rate of HBeAg positivity, and detectable HBV DNA might have led to completely inactive cirrhosis or resolving fibrosis.35 This hypothesis might explain the similar incidence of HCC between patients with LSM ≤13 kPa and cLC and those with LSM ≤13 kPa and without cLC.