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Abstract Details
Long-term evolution of LI-RADS observations in HCV-related cirrhosis treated with direct-acting antivirals
Roberto Cannella12, Federica Vernuccio1234, Ciro Celsa25, Giuseppe Cabibbo2, Vincenza Calvaruso2, Silvia Greco1, Salvatore Battaglia6, Kingshuk Roy Choudhury7, An Tang8, Massimo Midiri1, Vito Di Marco2, Calogero Cammà2, Giuseppe Brancatelli1
Author information
1Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy.
2Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127, Palermo, Italy.
3University Paris Diderot, Sorbonne Paris Cité, Paris, France.
4I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124, Messina.
5Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy.
6Department of Economics, Business and Statistics (SEAS), University of Palermo, Italy.
7Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States.
8Department of Radiology, Centre Hospitalier de l'Université de Montréal, rue Saint-Denis, 1000, Montréal, Québec, H2X 0C2, Canada.
Abstract
Background & aims: The risk of progression of indeterminate observations to hepatocellular carcinoma (HCC) after direct-acting antivirals (DAA) is still undetermined. To assess whether DAA therapy changes the risk of progression of observations with low (LR-2), intermediate (LR-3), and high (LR-4) probability for HCC in cirrhotic patients and to identify predictors of progression.
Methods: This retrospective study included cirrhotic patients treated with DAA who achieved sustained virologic response between 2015 and 2019. A total of 68 patients had pre-DAA indeterminate observations and at least six months CT/MRI follow-up before and after DAA. Two radiologists reviewed CT/MRI studies to categorize observations according to the LI-RADSv2018 and assess the evolution on subsequent follow-ups. Predictors of evolutions were evaluated by using the Cox proportional hazard model, Kaplan-Meier method, and log-rank test.
Results: A total of 109 untreated observations were evaluated, including 31 (28.4%) LR-2, 67 (61.5%) LR-3, and 11 (10.1%) LR-4. During a median follow-up of 41 months, 17.4% and 13.3% of observations evolved to LR-5 or LR-M and LR-5, before and after DAA, respectively (P=0.428). There was no difference in rate of progression of neither LR-2 (P=1.000), LR-3 (P=0.833), or LR-4 (P=0.505). At multivariate analysis, only initial LI-RADS category was an independent predictor of progression to LR-5 or LR-M for all observations (hazard ratio 6.75, P<0.001), and of progression to LR-5 after DAA (hazard ratio 4.34, P=0.047).
Conclusions: DAA therapy does not increase progression of indeterminate observations to malignant categories. The initial LI-RADS category is an independent predictor of observations upgrade.