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Long‐term evolution of LI‐RADS observations in HCV‐related cirrhosis treated with direct‐acting antivirals
Author(s) -
Cannella Roberto,
Vernuccio Federica,
Celsa Ciro,
Cabibbo Giuseppe,
Calvaruso Vincenza,
Greco Silvia,
Battaglia Salvatore,
Choudhury Kingshuk Roy,
Tang An,
Midiri Massimo,
Di Marco Vito,
Cammà Calogero,
Brancatelli Giuseppe
Publication year - 2021
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14914
Subject(s) - medicine , hazard ratio , hepatocellular carcinoma , proportional hazards model , cirrhosis , tumor progression , gastroenterology , oncology , nuclear medicine , confidence interval , cancer
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.