Direct-Acting Antiviral Agents Reduce the Risk of Malignant Transformation of Hepatobiliary Phase-Hypointense Nodule without Arterial Phase Hyperenhancement to Hepatocellular Carcinoma on Gd-EOB-DPTA-Enhanced Imaging in the Hepatitis C Virus-Infected Live
Direct-Acting Antiviral Agents Reduce the Risk of Malignant Transformation of Hepatobiliary Phase-Hypointense Nodule without Arterial Phase Hyperenhancement to Hepatocellular Carcinoma on Gd-EOB-DPTA-Enhanced Imaging in the Hepatitis C Virus-Infected Live
复制标题
直接作用抗病毒药物可降低丙型肝炎病毒感染活体中 Gd-EOB-DPTA 增强成像无动脉期高增强的肝胆期低信号结节恶性转化为肝细胞癌的风险
DOI：
10.1159/000504889
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发表时间：
2020
期刊：
影响因子：
13.8
通讯作者：
Kaneko Shuichi
中科院分区：
文献类型：
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作者：
Shimizu Yoshiaki;Arai Kuniaki;Yamashita Taro;Yamashita Tatsuya;Shimakami Tetsuro;Kawaguchi Kazunori;Kitamura Kazuya;Sakai Yoshio;Mizukoshi Eishiro;Honda Masao;Kitao Azusa;Kozaka Kazuto;Kobayashi Satoshi;Kaneko Shuichi
背景和目的：钆-乙氧苄基-二乙烯三胺增强磁共振成像（Gd-EOB-DTPA-enhanced MRI）显示的肝胆相低信号结节（HHN无APHE）被认为是不典型增生结节或早期肝细胞癌（HCC），并且具有发生恶性转化和进展为富血供HCC的高风险。本研究的目的是评估HHN无APHE诊断Gd-EOB-DTPA增强MRI根除HCV前的直接作用的抗病毒药物（DAAs）的临床结果：我们回顾性研究了221例连续的HCV感染患者谁与DAAs治疗。30例患者（65例HHN无APHE）入组持续病毒学应答（SVR）队列，22例患者（43例HHN无APHE）未接受DAA或HCV根除治疗失败入组非SVR队列。SVR组中57%的患者和非SVR组中64%的患者有HCC病史。本研究的主要终点是从影像学上未检测到APHE的HHN发展为富血管性HCC。两个队列的累积发病率和相对危险度的进展为多血管肝癌的临床特征进行了比较cohols.Results：2年累积发病率进展为多血管肝癌分别为8.5%和21.9%，在SVR和非SVR队列。在HCV根除后，无APHE的HHN向HCC的进展显著减少（p= 0.022，对数秩检验）。多因素考克斯回归分析显示T2加权像高信号（相对危险度14.699，p < 0.001）和获得SVR（相对危险度0.290，p = 0.043）是与HCC风险相关的独立因素。随访期间，SVR队列中6例（9.2%）无APHE的HHN在肝细胞期images.Conclusions上无法检测到：通过DAA根除HCV可降低无APHE的HHN的过度血管化率，其中一些结节消失。
Background and Aims:Hepatobiliary phase-hypointense nodules without arterial phase hyperenhancement (HHNs without APHE) on gadolinium-ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) are considered to be dysplastic nodules or early hepatocellular carcinoma (HCC) and have high risk of undergoing malignant transformation and progression to hypervascular HCC. The aim of this study was to evaluate the clinical outcome of HHNs without APHE diagnosed by Gd-EOB-DTPA-enhanced MRI before the eradication of HCV by direct-acting antiviral agents (DAAs).Methods:We retrospectively investigated 221 consecutive patients with HCV infection who were treated with DAAs. Thirty patients with 65 HHNs without APHE were enrolled in a sustained virologic response (SVR) cohort and 22 with 43 HHNs without APHE who did not receive DAAs or had failed HCV eradication therapy were enrolled in a non-SVR cohort. Fifty-seven percent of patients in the SVR group and 64% of those in the non-SVR group had a history of HCC. The primary endpoint of this study was the development of hypervascular HCC from HHNs without APHE detected on imaging. The cumulative incidence and relative risk of progression to hypervascular HCC in relation to clinical characteristics were compared between the two cohorts.Results:The 2-year cumulative incidence of progression to hypervascular HCC was 8.5 and 21.9% in the SVR and non-SVR cohorts, respectively. There was a significant reduction in progression of HHNs without APHE to HCC after the eradication of HCV (p= 0.022, log-rank test). Multivariate Cox regression analysis identified hyperintensity on T2-weighted images (relative risk 14.699,p< 0.001) and achieving SVR (relative risk 0.290,p= 0.043) as independent factors associated with the risk of HCC. During follow-up, 6 (9.2%) of the HHNs without APHE in the SVR cohort became undetectable on hepatocyte-phase images.Conclusions:Eradication of HCV by DAAs could reduce the hypervascularization rate of HHNs without APHE, and some of these nodules disappeared.