Section of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy.
Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.
Liver Int. 2021 Sep;41(9):2179-2188. doi: 10.1111/liv.14914. Epub 2021 May 18.
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.
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.
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).
DAA therapy does not increase progression of indeterminate observations to malignant categories. The initial LI-RADS category is an independent predictor of observations upgrade.
直接作用抗病毒药物（DAA）治疗后，不确定观察结果进展为肝细胞癌（HCC）的风险仍不确定。本研究旨在评估 DAA 治疗是否会改变肝硬化患者中 HCC 低（LR-2）、中（LR-3）和高（LR-4）概率观察结果进展的风险，并确定进展的预测因素。
本回顾性研究纳入了 2015 年至 2019 年期间接受 DAA 治疗并获得持续病毒学应答的肝硬化患者。共有 68 例患者在 DAA 治疗前和 DAA 治疗后至少有 6 个月的 CT/MRI 随访时存在 DAA 治疗前不确定观察结果。两位放射科医生对 CT/MRI 研究进行了回顾，根据 LI-RADSv2018 对观察结果进行分类，并评估后续随访中的演变情况。使用 Cox 比例风险模型、Kaplan-Meier 方法和对数秩检验评估演变的预测因素。
共评估了 109 例未治疗的观察结果，包括 31 例（28.4%）LR-2、67 例（61.5%）LR-3 和 11 例（10.1%）LR-4。在中位随访 41 个月期间，分别有 17.4%和 13.3%的观察结果在 DAA 治疗前和治疗后进展为 LR-5 或 LR-M 和 LR-5（P=.428）。LR-2（P=1.000）、LR-3（P=.833）或 LR-4（P=.505）的进展率无差异。多变量分析显示，只有初始 LI-RADS 类别是所有观察结果进展为 LR-5 或 LR-M（风险比 6.75，P<0.001）以及 DAA 治疗后进展为 LR-5 的独立预测因素（风险比 4.34，P=.047）。
DAA 治疗不会增加不确定观察结果进展为恶性类别的风险。初始 LI-RADS 类别是观察结果升级的独立预测因素。
