{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:35:42Z","timestamp":1788554142157,"version":"build-2803163510"},"reference-count":32,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Cancer"],"abstract":"<jats:p>Background\/Aims: Hepatic decompensation (HD) following systemic treatment, including atezolizumab + bevacizumab (Atezo\/Bev) and tyrosine kinase inhibitors (TKIs), is a critical prognostic event in advanced hepatocellular carcinoma (HCC). This study aimed to evaluate the predictive utility of liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) for HD incidence post-treatment. Methods: This multicenter study included 396 HCC patients who received systemic therapy (Atezo\/Bev or TKIs) and underwent VCTE prior to treatment at seven university-affiliated hospitals. Clinical outcomes including HD independent of tumor progression, variceal bleeding (VB), overall survival (OS), and progression-free survival (PFS) were assessed. A 25 kPa LSM threshold, based on Baveno VII criteria, stratified patients into high and low LSM groups. Results: Of the 396 patients, 176 received Atezo\/Bev, while 45 and 175 received lenvatinib and sorafenib, respectively. Treatment distribution was similar between high and low LSM groups (p = 0.546). High LSM was associated with increased HD risk (HR = 3.00, p &lt; 0.001), VB risk (HR = 2.34, p = 0.048), and a trend toward worse OS (HR = 1.27, p = 0.065). In the low LSM group, Atezo\/Bev outperformed TKIs in OS and PFS (p &lt; 0.05) without increasing HD risk. In contrast, in the high LSM group, Atezo\/Bev and TKIs showed no OS or PFS differences, but Atezo\/Bev significantly increased HD and VB risk (p &lt; 0.05). A risk score based on four variables (Child-Pugh score 5, LSM \u226525 kPa, multiple tumors, and high-grade portal vein tumor thrombosis) showed good predictive accuracy for HD at 12 months (AUC = 0.832) and effectively identified patients at high risk for HD, VB, and poor survival (p &lt; 0.005). Conclusion: LSM by VCTE predicts HD following systemic treatment in advanced HCC. In patients with high LSM, Atezo\/Bev increases HD risk, warranting careful treatment selection.<\/jats:p>","DOI":"10.1159\/000550440","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T17:00:51Z","timestamp":1770310851000},"page":"1-15","source":"Crossref","is-referenced-by-count":1,"title":["Liver Stiffness Measured by Vibration-Controlled Transient Elastography Predicts Hepatic Decompensation in Patients with Hepatocellular Carcinoma Receiving Systemic Treatments"],"prefix":"10.1159","author":[{"given":"Jaejun","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1727-7842","authenticated-orcid":false,"given":"Si 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