日本东京大学荣誉教授Masao Omata
Hepatology Digest: You have reported that liver stiffness is strongly associated with the risk of HCC. Would you like to tell us the significance of evaluating the risk of HCC and how to evaluate the risk of HCC by FibroScan?
Professor Omata: I was very interested in identifying the high risk groups. There are many studies on the biochemical parameters but in daily clinical practice it is very difficult to categorize those people. I kept saying that platelet counting was very important and if it is beyond 200000/ml then you are at less risk and if it goes down to 100000/ml platelet count, your chances of getting cancer are maybe 3000-5000 per year. That is what I have kept saying for the last 25 years. Then FibroScan came.
Professor Omata: Actually I was trained as a pathologist. The concept of fibrosis is very familiar to a pathologist as we take biopsies and other liver samples. I was trained initially as a pathologist here at New Haven in 1973. Then for six years I read the liver biopsies and I also did the liver biopsies on my own when I went back to Japan in 1979. Sometimes I would take twenty liver biopsies in two hours but accidents happen like bleeding so sometimes it was very scary. Liver biopsy is not a treatment; it is a diagnosis. If something happens during the diagnosis process the patient gets very upset and nowadays you might be sued for malpractice. So I knew the importance of liver biopsy but I also knew that I wanted to avoid the procedure. When FibroScan came to Japan, I was very eager to do it because instead of sticking in a needle I could use a probe and I could check the liver stiffness. Therefore we did the first stiffness studies on hepatitis C patients and these were the first of their kind.
Professor Omata: Many studies were comparing histology and FibroScan but our study was utilizing FibroScan readings as the baseline for four years with over 870 patients. We clearly showed that where the FibroScan reading was below 10kPa, only two out of 511 were liver cancers. In contrast, 14.4% of those above 15kPa developed cancer. So we proved that in patients by prospective randomized clinical studies with HCC. That is my story about Fibroscan.
Hepatology Digest: In Japan, what aspects of FibroScan have been used for reasons other than evaluating the risk of HCC?
Professor Omata: Japan has seen a fast advancement of the procedure since its approval last year and there have been many areas, not just liver disease, where people are interested in checking stiffness. Of course, hepatitis C is a major one and also hepatitis B but now also NASH is increasing because twenty years ago, 10% hepatitis B-related hepatocellular carcinoma, 80% was hepatitis C.
Professor Omata: Now instead of hepatitis B, NASH non-viral cancers are 12%-15%, so more people are interested in checking liver stiffness for that growing number of NASH patients and metabolic cancers. I think there are three major indications to check for hepatocellular carcinoma: HBV, HCV and now NASH metabolic syndromes.
Hepatology Digest: Can you talk about the Asia-Pacific consensus about non-invasive diagnosis of liver fibrosis?
Professor Omata: In the APASL Guidelines, we have HBV, HCV and hepatocellular carcinoma but we do not have NASH guidelines. We did at one time put together liver fibrosis guidelines. At that time FibroScan was not available anyway so maybe pretty soon we have to set up new guidelines for fibrosis and for NASH. I think it is time that this was done as the last guidelines were written six or seven years ago so it is time to revise those.
