P381 Defining HCV cirrhosis by Fibroscan score has a significant impact on HCC surveillance burden

IntroductionPatients with hepatitis C (HCV) related cirrhosis should undergo 6 monthly hepatocellular carcinoma (HCC) surveillance, as this has been shown to be effective in increasing longevity where the incidence of HCC is greater than 1.5% per year.1 NHS England define HCV cirrhosis on Fibroscan®/transient elastography (TE) as a liver stiffness measure (LSM) >11.5 kPa2 prior to commencing direct-acting antiviral (DAA) treatment. AASLD guidelines define HCV cirrhosis as a LSM score of >12.5 kPa, and >14 kPa has been used in other studies.3 This lower score by NHS England may lead to a higher burden of HCC surveillance in HCV patients. This study aimed to assess the impact of HCC risk if higher LSM measurements are used to define cirrhosis, and to evaluate the impact on the subsequent ultrasound (US) surveillance burden.Methods100 patients with HCV with a LSM >11.5 kPa on TE using the local treatment database were identified, and from this 53 patients had a complete set of data at the time of the pre-DAA treatment Fibroscan® allowing a 3 year HCC percentage risk to be calculated using the validated HCC calculator.4 The cirrhosis parameter within the risk score calculator was defined as a Fibroscan® score of either >11.5 kPa, >12.5 kPa, or >14 kPa, and comparisons were made of HCC risk between HCV cirrhosis and non-cirrhosis patients depending on LSM cut off for cirrhosis in each of these groups. Statistical significance between cirrhotic and non-cirrhotic HCC risk was performed using a Mann-Whitney test, and reduction in US surveillance burden was calculated as a percentage.ResultsWhen HCV cirrhosis was defined as a LSM of >12.5 kPa, the 3 year risk of HCC was 2.91% compared to non-cirrhosis patients (LSM ≤12.5 kPa) who had a risk of 0.15% (p = 14 kPa conferred a 3 year HCC risk of 3.07% compared to non-cirrhosis (LSM ≤14 kPa) who had a risk of 0.24% (p = 0.0001). In both these groups where a higher LSM cut off for cirrhosis has been used, there was a significantly higher 3 year risk of HCC in the cirrhosis patients, and no patients within the non-cirrhosis groups had a 3 year HCC risk >1.5%.Abstract P381 Table 1 Cut off for cirrhosis on TE (LSM in kPa) Median 3 yr HCC risk (%) HCV cirrhosis HCV non-cirrhosis >11.5 2.46 - >12.5 2.91 0.15 >14 3.07 0.24 Increasing the TE definition of cirrhosis from >11.5 kPa to >14 kPa in this cohort led to a 42.7% reduction in 6 monthly US surveillance in this cohort.Conc