Study: MRE predicts HCC after SVR

A new study in the Journal of Viral Hepatitis found that magnetic resonance elastography (MRE) had much higher accuracy than serum-based markers for predicting risk of hepatocellular carcinoma (HCC) development after sustained virological response (SVR) for Hepatitis C treatment. Monitoring patients for subsequent development of HCC is clinically important, and the usefulness of noninvasive markers for prediction HCC has long been of interest to clinicians and researchers.

"This important study demonstrates the clinical utility of MRE for patients who receive direct acting antiviral (DAA) treatment for Hepatitis C," said Richard Ehman, MD, Mayo Clinic Radiologist and CEO of Resoundant.

The results of the study found that patients who achieved SVR, but had advanced fibrosis (defined as MRE kPa > 3.75), had a significantly higher risk of developing cancer in the years immediately following successful treatment. The hazard ratio for developing HCC was 3.5 times higher for patients with an MRE over 3.75 kPa.

"We've seen many health systems place fibrosis restrictions on patients in order to access these life-saving drugs. This study shows the risk that this approach introduces for patients, who are 3.5 times more likely to develop HCC if they don't receive treatment until they develop advanced fibrosis. I'm glad that many health systems have removed fibrosis restrictions and hope all other systems follow suit, as waiting until an advanced stage of fibrosis unnecessarily puts patients at heightened risk for adverse events like HCC."

The study provides support for using MRE to assess fibrosis load in patients receiving DAA treatment in order to determine those who would benefit from post-treatment surveillance for HCC.

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Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct‐acting antivirals

First published: 11 April 2019

https://doi.org/10.1111/jvh.13103

Abstract

Prediction of hepatocellular carcinoma (HCC) development after sustained virological response (SVR) is clinically important, and the usefulness of noninvasive markers for prediction HCC have been reported.

The aim of this study was to compare the prediction accuracy for HCC development by noninvasive markers. A total of 346 patients with chronic hepatitis C without history of HCC who achieved SVR through direct-acting antivirals were included. Magnetic resonance elastography (MRE) and serum fibrosis markers were measured 12 weeks after the end of treatment, and the subsequent HCC development was examined. The mean observation period was 26.4 ± 7.9 months, and 24 patients developed HCC. Area under the receiver operating characteristic curve of liver stiffness by MRE, Wisteria floribunda agglutinin-positive mac-2 binding protein and FIB-4 for predicting HCC within 3 years was 0.743, 0.697 and 0.647, respectively. The 1/2/3-year rates of HCC development in patients with liver stiffness ≥3.75 KPa were 6.6%, 11.9% and 14.5%, whereas they were 1.4%, 2.5% and 2.5% in patients with liver stiffness <3.75 KPa (P < 0.001). Multivariate analysis revealed that liver stiffness ≥3.75 was an independent predictive factor for HCC development (hazard ratio, 3.51; 95% confidence interval, 1.24-9.99). In subgroup analysis, there were 132 patients who were <73 years old and had liver stiffness <3.75 KPa, and no HCC development was observed in these patients.

Diagnostic accuracy for predicting HCC development was higher in MRE than serum fibrosis markers and measurement of liver stiffness by MRE could identify patients with high and low risk of HCC development after SVR.