Vernuccio Federica, Cannella Roberto, Cabibbo Giuseppe, Greco Silvia, Celsa Ciro, Matteini Francesco, Giuffrida Paolo, Midiri Massimo, Di Marco Vito, Cammà Calogero, Brancatelli Giuseppe
Department of Radiology, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy.
Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.
Diagnostics (Basel). 2022 May 10;12(5):1187. doi: 10.3390/diagnostics12051187.
To assess whether HCC (LR-5) occurrence may be associated with the presence of Liver Imaging Reporting and Data System (LI-RADS) indeterminate observations in patients with hepatitis C virus infection treated with direct acting antiviral (DAA) therapy.
This retrospective study included patients with HCV-related cirrhosis who achieved sustained virologic response (SVR) after DAA therapy between 2015 and 2019 and submitted to CT/MRI follow-ups with a minimum interval time of six months before and after DAA. Two blinded readers reviewed CT/MRI to categorize observations according to LI-RADS version 2018. Differences in rate of LI-RADS 5 observations (i.e., LR-5) before and after SVR were assessed. Time to LR-5 occurrence and risk factors for HCC after DAAs were evaluated by using Kaplan-Meier method and Cox proportional hazard model, respectively.
Our final study population comprised 115 patients (median age 72 years) with a median CT/MRI follow-up of 47 months (IQR 26-77 months). Twenty-nine (25.2%) patients were diagnosed with LR-5 after DAA. The incidence of LR-5 after DAAs was 10.4% (12/115) at one year and 17.4% (20/115) at two years. LR-5 occurrence after DAA was significantly higher in patients with Child Pugh class B (log-rank = 0.048) and with LR-3 or LR-4 observations (log-rank = 0.024). At multivariate analysis, Child-Pugh class B (hazard ratio 2.62, = 0.023) and presence of LR-3 or LR-4 observations (hazard ratio 2.40, = 0.048) were independent risk factors for LR-5 occurrence after DAA therapy.
The presence of LR-3 and LR-4 observations significantly increases HCC risk following the eradication of HCV infection.
评估在接受直接作用抗病毒（DAA）治疗的丙型肝炎病毒感染患者中，肝细胞癌（LR-5）的发生是否可能与肝脏影像报告和数据系统（LI-RADS）不确定观察结果的存在有关。
这项回顾性研究纳入了2015年至2019年间接受DAA治疗后实现持续病毒学应答（SVR）且接受CT/MRI随访的丙型肝炎相关肝硬化患者，DAA治疗前后的最小间隔时间为6个月。两名盲法阅片者根据2018版LI-RADS对CT/MRI进行评估以对观察结果进行分类。评估SVR前后LI-RADS 5观察结果（即LR-5）的发生率差异。分别采用Kaplan-Meier法和Cox比例风险模型评估出现LR-5的时间以及DAA治疗后肝细胞癌的危险因素。
我们的最终研究人群包括115例患者（中位年龄72岁），CT/MRI中位随访时间为47个月（四分位间距26 - 77个月）。29例（25.2%）患者在DAA治疗后被诊断为LR-5。DAA治疗后1年LR-5的发生率为10.4%（12/115），2年时为17.4%（20/115）。Child-Pugh B级患者（对数秩检验 = 0.048）以及有LR-3或LR-4观察结果的患者（对数秩检验 = 0.024）在DAA治疗后出现LR-5的情况显著更高。在多变量分析中，Child-Pugh B级（风险比2.62， = 0.023）和存在LR-3或LR-4观察结果（风险比2.40， = 0.048）是DAA治疗后出现LR-5的独立危险因素。
LR-3和LR-4观察结果的存在显著增加了丙型肝炎病毒感染根除后肝细胞癌的风险。
