Long‐term evolution of LI‐RADS observations in HCV‐related cirrhosis treated with direct‐acting antivirals
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)...
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Published in | Liver international Vol. 41; no. 9; pp. 2179 - 2188 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Wiley Subscription Services, Inc
01.09.2021
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Subjects | |
Online Access | Get full text |
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Summary: | 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 virological 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 = .428). There was no difference in rate of progression of neither LR‐2 (P = 1.000), LR‐3 (P = .833) or LR‐4 (P = .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 < .001), and of progression to LR‐5 after DAA (hazard ratio 4.34, P = .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. |
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Bibliography: | Funding information Ana Lleo No funding was received for this study. Handling Editor ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1478-3223 1478-3231 |
DOI: | 10.1111/liv.14914 |