ERS3069. Significance of Hepatic Venous Pressure Gradient in Surveillance of HCC in Patients With Pre-Cirrhotic Bridging Fibrosis Liver Disease
Authors* Denotes Presenting Author
Tuan Vu *;
Penn State College of Medicine
Hanel Eberly;
Penn State College of Medicine
Benjamin Shin;
George Washington University Hospital
Jeffrey Cruz;
Temple University Hospital
Kathryn McGillen;
Penn State Health Milton S. Hershey Medical Center
Objective:
Surveillance for HCC is not currently recommended for all noncirrhotic patients with varied consensus between major guidelines. Our study compares the rate of surveillance for HCC between pathology proven pre-cirrhotic bridging fibrosis (METAVIR score F3) patients with and without clinically significant portal hypertension (CSPH, HVPG = 10 mmHg).
Materials and Methods:
126 consecutive patients with pathology proven bridging fibrosis without cirrhosis, HVPG measurement obtained during the same outpatient transjugular liver biopsy, no prior history of HCC and sufficient clinical data of two years or greater from biopsy date were retrospectively reviewed between 2012 and 2019. Primary endpoints included the rate of surveillance for HCC between patients with and without CSPH.
Results:
Among 126 patients with bridging fibrosis (67 females and 59 males; average age 56 years), 41 (33%) and 85 (67%) were with and without CSPH (HVPG = 10 mmHg). Median follow-up time was 4 years. There was no difference in distribution of liver disease's etiology between patients with and without CSPH. 85/126 (67%) received imaging surveillance for HCC. The rate of surveillance for HCC in patients with and without CSPH respectively was 34/41 (83%) vs 50/85 (59%) (p = .009). The median time between pathology diagnosis and the first surveillance imaging in patients with and without CSPH respectively was 9 and 21 months. The choice of imaging modality for surveillance in patients with and without CSPH respectively was 12/34 (35%) and 25/50 (50%) Ultrasound Abdomen, 4/34 (12%) and 3/50 (6%) MRI abdomen with and without IV contrast, 16/34 (47%) and 19/50 (38%) CT abdomen with IV contrast multiphase. The rate of detected lesions concerning for HCC in patients with and without CSPH respectively was 3/34 (9%) and 6/50 (12%), with the mean largest diameter of detected lesion being 2.8 cm (range, 1.7-3.8) and 3.3 cm (range, 0.5-7.9), and the median time from biopsy to detection being 9 and 43 months.
Conclusion:
Patients with pre-cirrhotic bridging fibrosis and CSPH received a higher rate of imaging surveillance for HCC with varied modality choice according to ACR Appropriateness Criteria. Measuring HVPG provides additional clinical value in deciding surveillance strategy for HCC in patients with pre-cirrhotic advanced bridging fibrosis.
