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Assessing Fibrosis in the â Post Liver Biopsy ERAâTM of Hepatitis C Treatment: A Comparison of APRI, FIB-4, Fibrotest, and Shear Wave Elastography (SWE)
population, 891 patients (27.5%) had only substance abuse, 403 (12.4%) had only a mental health disorder, 1220 (37.7%) had both substance abuse and mental health disorder and 718 (22.2%) had neither of those conditions. From our Hepatitis C on therapy and treated population, 287 (65.9%) had only substance abuse, 148 (34.1%) had only mental health disease, 186 (42.7%) had both mental health and substance abuse and 93 (21.3%) had none of these conditions. The most common diagnoses in the treated and on therapy population (435) were depression with 140 patients (32.1%) , drug abuse in remission with 55 patients (12.6%) and alcohol in remission with 45 (10.34%). Discussion: Our results indicate that mental health and substance abuse issues are very common in our urban underserved primary care based HCV treatment program. Per our results, having a substance abuse disorder or mental health disease is not a limitation for treating patients, especially if involves drug and alcohol in remission or depression, instead of more severe conditions such as IVDU, amphetamine use or schizophrenia, that could impair adherence to treatment and follow up. Our results indicate that having both conditions (mental health and substance abuse) was similar in patients on therapy and successfully treated with 186 patients (42.7%) than the overall Hepatitis C program population with 1220 (37.7%).
Mo1406 RACIAL AND SOCIOECONOMIC DISPARITIES IN THE INCIDENCE RATES AND SURVIVAL OF GALLBLADDER CANCER IN THE UNITED STATES Veeravich Jaruvongvanich, Ju Dong Yang, Thoetchai Peeraphatdit, Lewis R. Roberts
AASLD Abstracts
Background/Objective Gallbladder cancer is a rare malignancy in most countries. Racial and sociodemographic factors associated with incidence and survival are poorly defined. We aimed to investigate the population-based gallbladder cancer incidence and survival trends by clinical characteristics and sociodemographic factors in the United States. Methods Gallbladder cancer incidence and survival data from 2001-2012 were obtained from the Surveillance, Epidemiology and End Results 18 registries. Incidence rates and Joinpoint trends were calculated by demographic subgroup. Survival trends were assessed using Cox proportional hazards models. Results A total of 7,769 patients were identified. Overall gallbladder cancer incidence rates did not significantly change during the 2001-2012 period (Figure 1). Incidence rates were 3 times higher in Hispanics and 1.6 times higher in Blacks compared to Whites. Over the time period, incidence rates significantly increased among Blacks and decreased among Hispanics. Male sex (HR: 1.10, 95%CI: 1.03-1.17), older age (HR: 1.73, 95%CI: 1.53-1.96), single and divorced statuses (HR: 1.19, 95%CI: 1.09-1.30 and 1.12, 95%CI: 1.01-1.24) were independently associated with shorter overall survival whereas higher education (HR: 0.89, 95%CI: 0.82-0.97) and higher income (HR: 0.89, 95%CI: 0.82-0.96) were associated with longer survival (Table 1). Furthermore, overall survival has improved in all races/ethnicities except for Hispanics and Blacks (Table 2). Conclusions Overall incidence rates for gallbladder cancer were stable during 2001-2012. Hispanics have the highest incidence rates but incidence rates in Blacks are on the rise. Hispanics and Blacks demonstrated no improvement in cancer survival over time and could be target groups for future studies to address treatment disparities. Table 1 Results from the multivariable Cox regression examining factors associated with risk of death in patients with Gallbladder cancer
Mo1405 ˜ POST LIVER BIOPSY ERA’ OF ASSESSING FIBROSIS IN THE †HEPATITIS C TREATMENT: A COMPARISON OF APRI, FIB-4, FIBROTEST, AND SHEAR WAVE ELASTOGRAPHY (SWE) Amber J. Ortega, Danelle Wallace, Christian B. Ramers Introduction: Due to cost, risks, patient preference, and the availability of non-invasive staging methodologies, liver biopsy is increasingly uncommon in staging liver fibrosis in Hepatitis C (HCV) treatment. Among currently available non-invasive staging methods (APRI, Fib-4, Fibrotest, and Elastography), none are perfect, and clinicians often employ multiple methodologies in staging algorithms. We undertook this analysis to demonstrate the correlation and frequency of concordance of four non-invasive fibrosis staging methodologies (APRI, FIb-4, Fibrotest, and Shear Wave Elastography, SWE) in a real-world cohort of HCV-infected patients. Studies have shown that there is a direct correlation between liver fibrosis and parenchymal stiffness. SWE uses a real-time 2D ultrasonic image platform, with a superimposed quantitative representation of the stiffness of a given area of a region of interest of the liver. This is important clinically because the prognosis and management of chronic HCV is mainly dependent on the extent of liver fibrosis, currently with liver histologic analysis being the gold standard. Methods: We devised a study to describe the correlation of the APRI/Fib-4/Fibrotest vs SWE in our large underserved primary care-based HCV treatment program. We included all patients undergoing SWE evaluation. 510 patients were initially reviewed, and after exclusion criteria applied for completeness of records, and full fibrosis evaluation, we focused on 290 patients with HCV who had undergone complete fibrosis staging with all methods. Staging methodologies were compared against SWE and analyzed using SAS statistical analysis software. Pearson correlation coefficients were calculated, and pairwise comparisons were plotted. For each patient SWE staging was classified as concordant or discordant relative to the three other staging methods. Results: In our analyses, SWE showed strong correlation with the three other non-invasive staging methodologies. When evaluated specifically by predicted METAVIR stage, SWE was concordant with Fibrotest 49% of the time (92/187). Similar concordance was seen when SWE was compared to APRI (43%, 99/230), and Fib-4 (49%, 113/231). Discordance between SWE and other methodologies did not appear to skew in any one direction. We found our correlation coefficient to be 0.53 between Fibrotest and SWE fibrosis scores. Similarly, the correlation coefficients for SWE with APRI and Fib-4 are 0.48 and 0.54, respectively. Discussion: SWE is comparable to APRI, Fib-4, and Fibrotest for fibrosis staging in HCV patients undergoing evaluation for treatment. Results were concordant roughly half the time. Future progress in this research would include a paired study with pre- and post-treatment SWE images with fibrosis scoring to monitor for potential regression in parenchymal liver stiffness in cured HCV patients.
AASLD Abstracts
Abbreviation: AI/AN: American Indian and Alaskan Native. Variables for adjustment: Age (Categorical), sex, race, year of diagnosis, marital status, histologic subtypes, grade, historic stage, lymph node, tumor size, surgery, and radiation
S-1172
Mo1406 RACIAL AND SOCIOECONOMIC DISPARITIES IN THE INCIDENCE RATES AND SURVIVAL OF GALLBLADDER CANCER IN THE UNITED STATES Veeravich Jaruvongvanich, Ju Dong Yang, Thoetchai Peeraphatdit, Lewis R. Roberts
AASLD Abstracts
Background/Objective Gallbladder cancer is a rare malignancy in most countries. Racial and sociodemographic factors associated with incidence and survival are poorly defined. We aimed to investigate the population-based gallbladder cancer incidence and survival trends by clinical characteristics and sociodemographic factors in the United States. Methods Gallbladder cancer incidence and survival data from 2001-2012 were obtained from the Surveillance, Epidemiology and End Results 18 registries. Incidence rates and Joinpoint trends were calculated by demographic subgroup. Survival trends were assessed using Cox proportional hazards models. Results A total of 7,769 patients were identified. Overall gallbladder cancer incidence rates did not significantly change during the 2001-2012 period (Figure 1). Incidence rates were 3 times higher in Hispanics and 1.6 times higher in Blacks compared to Whites. Over the time period, incidence rates significantly increased among Blacks and decreased among Hispanics. Male sex (HR: 1.10, 95%CI: 1.03-1.17), older age (HR: 1.73, 95%CI: 1.53-1.96), single and divorced statuses (HR: 1.19, 95%CI: 1.09-1.30 and 1.12, 95%CI: 1.01-1.24) were independently associated with shorter overall survival whereas higher education (HR: 0.89, 95%CI: 0.82-0.97) and higher income (HR: 0.89, 95%CI: 0.82-0.96) were associated with longer survival (Table 1). Furthermore, overall survival has improved in all races/ethnicities except for Hispanics and Blacks (Table 2). Conclusions Overall incidence rates for gallbladder cancer were stable during 2001-2012. Hispanics have the highest incidence rates but incidence rates in Blacks are on the rise. Hispanics and Blacks demonstrated no improvement in cancer survival over time and could be target groups for future studies to address treatment disparities. Table 1 Results from the multivariable Cox regression examining factors associated with risk of death in patients with Gallbladder cancer
Mo1405 ˜ POST LIVER BIOPSY ERA’ OF ASSESSING FIBROSIS IN THE †HEPATITIS C TREATMENT: A COMPARISON OF APRI, FIB-4, FIBROTEST, AND SHEAR WAVE ELASTOGRAPHY (SWE) Amber J. Ortega, Danelle Wallace, Christian B. Ramers Introduction: Due to cost, risks, patient preference, and the availability of non-invasive staging methodologies, liver biopsy is increasingly uncommon in staging liver fibrosis in Hepatitis C (HCV) treatment. Among currently available non-invasive staging methods (APRI, Fib-4, Fibrotest, and Elastography), none are perfect, and clinicians often employ multiple methodologies in staging algorithms. We undertook this analysis to demonstrate the correlation and frequency of concordance of four non-invasive fibrosis staging methodologies (APRI, FIb-4, Fibrotest, and Shear Wave Elastography, SWE) in a real-world cohort of HCV-infected patients. Studies have shown that there is a direct correlation between liver fibrosis and parenchymal stiffness. SWE uses a real-time 2D ultrasonic image platform, with a superimposed quantitative representation of the stiffness of a given area of a region of interest of the liver. This is important clinically because the prognosis and management of chronic HCV is mainly dependent on the extent of liver fibrosis, currently with liver histologic analysis being the gold standard. Methods: We devised a study to describe the correlation of the APRI/Fib-4/Fibrotest vs SWE in our large underserved primary care-based HCV treatment program. We included all patients undergoing SWE evaluation. 510 patients were initially reviewed, and after exclusion criteria applied for completeness of records, and full fibrosis evaluation, we focused on 290 patients with HCV who had undergone complete fibrosis staging with all methods. Staging methodologies were compared against SWE and analyzed using SAS statistical analysis software. Pearson correlation coefficients were calculated, and pairwise comparisons were plotted. For each patient SWE staging was classified as concordant or discordant relative to the three other staging methods. Results: In our analyses, SWE showed strong correlation with the three other non-invasive staging methodologies. When evaluated specifically by predicted METAVIR stage, SWE was concordant with Fibrotest 49% of the time (92/187). Similar concordance was seen when SWE was compared to APRI (43%, 99/230), and Fib-4 (49%, 113/231). Discordance between SWE and other methodologies did not appear to skew in any one direction. We found our correlation coefficient to be 0.53 between Fibrotest and SWE fibrosis scores. Similarly, the correlation coefficients for SWE with APRI and Fib-4 are 0.48 and 0.54, respectively. Discussion: SWE is comparable to APRI, Fib-4, and Fibrotest for fibrosis staging in HCV patients undergoing evaluation for treatment. Results were concordant roughly half the time. Future progress in this research would include a paired study with pre- and post-treatment SWE images with fibrosis scoring to monitor for potential regression in parenchymal liver stiffness in cured HCV patients.
AASLD Abstracts
Abbreviation: AI/AN: American Indian and Alaskan Native. Variables for adjustment: Age (Categorical), sex, race, year of diagnosis, marital status, histologic subtypes, grade, historic stage, lymph node, tumor size, surgery, and radiation
S-1172