Estimate of hepatocellular carcinoma''s ...
Document type :
Article dans une revue scientifique
PMID :
Permalink :
Title :
Estimate of hepatocellular carcinoma''s incidence in patients with alcoholic cirrhosis.
Author(s) :
Ganne-Carrie, Nathalie [Auteur]
Université Paris 13 [UP13]
Chaffaut, Cendrine [Auteur]
Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé [CRESS - U1153]
Bourcier, Valerie [Auteur]
Archambeaud, Isabelle [Auteur]
Perarnau, Jean-Marc [Auteur]
Oberti, Frederic [Auteur]
Roulot, Dominique [Auteur]
Université Paris 13 [UP13]
Moreno, Christophe [Auteur]
Louvet, Alexandre [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Dao, Thong [Auteur]
Moirand, Romain [Auteur]
Université de Rennes [UR]
Goria, Odile [Auteur]
Nguyen-Khac, Eric [Auteur]
Carbonell, Nicolas [Auteur]
Antonini, Teresa [Auteur]
Pol, Stanislas [Auteur]
Université Paris Descartes - Paris 5 [UPD5]
De Ledinghen, Victor [Auteur]
Ozenne, Violaine [Auteur]
Henrion, Jean [Auteur]
Peron, Jean-Marie [Auteur]
Université Toulouse III - Paul Sabatier [UT3]
Tran, Albert [Auteur]
Perlemuter, Gabriel [Auteur]
Amiot, Xavier [Auteur]
Savoirs, Textes, Langage (STL) - UMR 8163 [STL]
Zarski, Jean-Pierre [Auteur]
Beaugrand, Michel [Auteur]
Chevret, Sylvie [Auteur]
Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé [CRESS - U1153]
Université Paris 13 [UP13]
Chaffaut, Cendrine [Auteur]
Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé [CRESS - U1153]
Bourcier, Valerie [Auteur]
Archambeaud, Isabelle [Auteur]
Perarnau, Jean-Marc [Auteur]
Oberti, Frederic [Auteur]
Roulot, Dominique [Auteur]
Université Paris 13 [UP13]
Moreno, Christophe [Auteur]
Louvet, Alexandre [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Dao, Thong [Auteur]
Moirand, Romain [Auteur]
Université de Rennes [UR]
Goria, Odile [Auteur]
Nguyen-Khac, Eric [Auteur]
Carbonell, Nicolas [Auteur]
Antonini, Teresa [Auteur]
Pol, Stanislas [Auteur]
Université Paris Descartes - Paris 5 [UPD5]
De Ledinghen, Victor [Auteur]
Ozenne, Violaine [Auteur]
Henrion, Jean [Auteur]
Peron, Jean-Marie [Auteur]
Université Toulouse III - Paul Sabatier [UT3]
Tran, Albert [Auteur]
Perlemuter, Gabriel [Auteur]
Amiot, Xavier [Auteur]
Savoirs, Textes, Langage (STL) - UMR 8163 [STL]
Zarski, Jean-Pierre [Auteur]
Beaugrand, Michel [Auteur]
Chevret, Sylvie [Auteur]
Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé [CRESS - U1153]
Journal title :
Journal of Hepatology
Abbreviated title :
J. Hepatol.
Volume number :
69
Pages :
1274-1283
Publication date :
2018-12
ISSN :
1600-0641
Keyword(s) :
Compensated cirrhosis
Alcoholic liver disease
HCC
Competing risk analysis
Alcoholic liver disease
HCC
Competing risk analysis
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Background & Aims: More than 90% of cases of hepatocellular carcinoma (HCC) occur in patients with cirrhosis, of which alcohol is a major cause. The CIRRAL cohort aimed to assess the burden of complications in patients ...
Show more >Background & Aims: More than 90% of cases of hepatocellular carcinoma (HCC) occur in patients with cirrhosis, of which alcohol is a major cause. The CIRRAL cohort aimed to assess the burden of complications in patients with alcoholic cirrhosis, particularly the occurrence of HCC. Methods: Patients with biopsy-proven compensated alcoholic cirrhosis were included then prospectively followed. The main endpoint was the incidence of HCC. Secondary outcomes were incidence of hepatic focal lesions, overall survival (OS), liver-related mortality and event-free survival (EFS). Results: From October 2010 to April 2016, 652 patients were included in 22 French and Belgian centers. During follow-up (median 29 months), HCC was diagnosed in 43 patients. With the limitation derived from the uncertainty of consecutive patients’ inclusion and from a sizable proportion of dropouts (153/652), the incidence of HCC was 2.9 per 100 patient-years, and one- and two-year cumulative incidences of 1.8% and 5.2%, respectively. Although HCC fulfilled the Milan criteria in 33 cases (77%), only 24 patients (56%) underwent curative treatment. An explorative prognostic analysis showed that age, male gender, baseline alpha-fetoprotein, bilirubin and prothrombin were significantly associated with the risk of HCC occurrence. Among 73 deaths, 61 had a recorded cause and 27 were directly attributable to liver disease. At two years, OS, EFS and cumulative incidences of liver-related deaths were 93% (95% CI 90.5–95.4), 80.3% (95% CI 76.9–83.9), and 3.2% (95% CI 1.6–4.8) respectively. Conclusion: This large prospective cohort incompletely representative of the whole population with alcoholic cirrhosis showed: a) an annual incidence of HCC of up to 2.9 per 100 patient-years, suggesting that surveillance might be cost effective in these patients; b) a high proportion of HCC detected within the Milan criteria, but only one-half of detected HCC cases were referred for curative treatments; c) a two-year mortality rate of up to 7%. Lay summary: Cirrhosis is a risk factor for primary liver cancer, leading to recommendations for periodic screening. However, for alcohol-related liver disease the rational of periodic screening for hepatocellular carcinoma (HCC) is controversial, as registry and databased studies have suggested a low incidence of HCC in these patients and highly competitive mortality rates. In this study, a large cohort of patients with biopsy-proven alcoholic cirrhosis prospectively screened for HCC demonstrated a high annual incidence of HCC (2.9%) and a high percentage of small cancers theoretically eligible for curative treatment. This suggests that patients with liver disease related to alcohol should not be ruled out of screening.Show less >
Show more >Background & Aims: More than 90% of cases of hepatocellular carcinoma (HCC) occur in patients with cirrhosis, of which alcohol is a major cause. The CIRRAL cohort aimed to assess the burden of complications in patients with alcoholic cirrhosis, particularly the occurrence of HCC. Methods: Patients with biopsy-proven compensated alcoholic cirrhosis were included then prospectively followed. The main endpoint was the incidence of HCC. Secondary outcomes were incidence of hepatic focal lesions, overall survival (OS), liver-related mortality and event-free survival (EFS). Results: From October 2010 to April 2016, 652 patients were included in 22 French and Belgian centers. During follow-up (median 29 months), HCC was diagnosed in 43 patients. With the limitation derived from the uncertainty of consecutive patients’ inclusion and from a sizable proportion of dropouts (153/652), the incidence of HCC was 2.9 per 100 patient-years, and one- and two-year cumulative incidences of 1.8% and 5.2%, respectively. Although HCC fulfilled the Milan criteria in 33 cases (77%), only 24 patients (56%) underwent curative treatment. An explorative prognostic analysis showed that age, male gender, baseline alpha-fetoprotein, bilirubin and prothrombin were significantly associated with the risk of HCC occurrence. Among 73 deaths, 61 had a recorded cause and 27 were directly attributable to liver disease. At two years, OS, EFS and cumulative incidences of liver-related deaths were 93% (95% CI 90.5–95.4), 80.3% (95% CI 76.9–83.9), and 3.2% (95% CI 1.6–4.8) respectively. Conclusion: This large prospective cohort incompletely representative of the whole population with alcoholic cirrhosis showed: a) an annual incidence of HCC of up to 2.9 per 100 patient-years, suggesting that surveillance might be cost effective in these patients; b) a high proportion of HCC detected within the Milan criteria, but only one-half of detected HCC cases were referred for curative treatments; c) a two-year mortality rate of up to 7%. Lay summary: Cirrhosis is a risk factor for primary liver cancer, leading to recommendations for periodic screening. However, for alcohol-related liver disease the rational of periodic screening for hepatocellular carcinoma (HCC) is controversial, as registry and databased studies have suggested a low incidence of HCC in these patients and highly competitive mortality rates. In this study, a large cohort of patients with biopsy-proven alcoholic cirrhosis prospectively screened for HCC demonstrated a high annual incidence of HCC (2.9%) and a high percentage of small cancers theoretically eligible for curative treatment. This suggests that patients with liver disease related to alcohol should not be ruled out of screening.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Inserm
Université de Lille
CHU Lille
Université de Lille
CHU Lille
Research team(s) :
Inflammatory digestive disease : pathophysiology and therapeutic targets developement
Submission date :
2019-03-01T14:35:25Z
2023-12-14T15:21:23Z
2023-12-14T15:21:23Z
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