The relationship between liver disease stage and liver fibrosis: a tangled web

Giacomo Germani (1) , Andrew Kenneth Burroughs (1) , Amar Paul Dhillon (2)

1 The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery UCL
2 Department of Cellular Pathology, Royal Free Campus

The structural consequences of chronic liver disease are described as a series of liver disease “stages” with scarring and architectural change that eventually destroys and replaces the normal lobular structure of the liver. Fibrosis (“excess collagen”) and stage have been confused in histological staging systems. Fibrosis is part of increasing liver disease stage, but fibrosis and stage are different. Staging liver disease is important in routine histopathological assessment. Measurement of liver fibrosis is another process. The collagenous proportion of a liver biopsy (collagen proportionate area, CPA) correlates with hepatic venous pressure gradient (HVPG), which is of recognised prognostic value. CPA at 1 year post-transplantation in HCV infected patients predicts subsequent clinical decompensation. CPA in cirrhotic patients predicts decompensation more accurately than staging or HVPG. The “cirrhosis” stage category has poor prognostic power, and CPA effectively substages cirrhosis. CPA improves the description of liver disease stage. Proper validation of antifibrotic treatments and “non-invasive markers of liver fibrosis” requires measurement of liver fibrosis (and not liver biopsy stage scores). It is unacceptable for the words “fibrosis” and “score” to remain next to each other. There are benefits of properly understanding liver fibrosis and liver disease stage and properly assessing each of them.

Mots clés: Medicine

Giacomo Germani, Andrew Kenneth Burroughs, Amar Paul Dhillon. The relationship between liver disease stage and liver fibrosis: a tangled web. Histopathology, 2010, 57 (6), pp.773. ⟨10.1111/j.1365-2559.2010.03609.x⟩. ⟨hal-00574821⟩