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Ollivier-Hourmand I, Repesse Y, Nahon P, Chaffaut C, Dao T, Nguyen TTN, Marcellin P, Roulot D, De Ledinghen V, Pol S, Guyader D, Archambeaud I, Zoulim F, Oberti F, Tran A, Bronowicki JP, D'Alteroche L, Ouzan D, Peron JM, Zarski JP, Bourliere M, Larrey D, Louvet A, Cales P, Abergel A, Mathurin P, Mallat A, Blanc JF, Nguyen-Khac E, Riachi G, Alric L, Serfaty L, Antonini T, Moreno C, Attali P, Thabut D, Pilette C, Grange JD, Silvain C, Carbonell N, Bernard-Chabert B, Goria O, Wartelle C, Moirand R, Christidis C, Perlemuter G, Ozenne V, Henrion J, Hillaire S, Di Martino V, Amiot X, Sutton A, Barget N, Chevret S, Ganne-Carrie N. ABO blood group does not influence Child-Pugh A cirrhosis outcome: An observational study from CIRRAL and ANRS CO12 CIRVIR cohorts. Liver Int 2022; 42:1386-1400. [PMID: 35025128 DOI: 10.1111/liv.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Non-O blood group promotes deep vein thrombosis and liver fibrosis in both general population and hepatitis C. We aimed to evaluate the influence of Non-O group on the outcome of Child-Pugh A cirrhotic patients. METHODS We used two prospective cohorts of Child-Pugh A cirrhosis due to either alcohol or viral hepatitis. Primary end point was the cumulated incidence of 'Decompensation' at 3 years, defined as the occurrence of ascites , hydrothorax, encephalopathy, gastrointestinal bleeding related to portal hypertension, or bilirubin >45 μmol/L. Secondary end points were the cumulated incidences of (1) 'Disease Progression' including a « decompensation» or « the occurrence of one or more parameters » among: prothrombin time (PT) <45%, albumin <28 g/L, Child-Pugh worsening (B or C vs A or B, C vs B), hepatorenal syndrome, and hepato-pulmonary syndrome, (2) other events such as non-malignant portal vein thrombosis (nmPVT), and (3) overall survival. RESULTS Patients (n = 1789; 59.9% Non-O group; 40.1% group O) were followed during a median of 65.4 months. At 3 years cumulated incidence of Decompensation was 8.3% in Non-O group and 7.2% in group O (P = .27). Cumulated incidence of Disease Progression was 20.7% in Non-O group and 18.9% in group O (P = .26). Cumulated incidence of nmPVT was 2.7% in Non-O group and 2.8% in group O (P = .05). At 3 years overall survival was 92.4% in Non-O group and 93.4% in group O (P = 1). CONCLUSION Non-O group does not influence disease outcome in Child-Pugh A cirrhotic patients. Clinicals trial number NCT03342170.
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Affiliation(s)
| | - Yohann Repesse
- Hematology Laboratory, University Hospital, Caen, France
| | - Pierre Nahon
- AP-HP, Hôpital Avicenne, Bobigny, France.,University Sorbonne Paris Nord, Bobigny, France.,Inserm, UMR-1138 « Functional Genomics of Solid Tumors », Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Thông Dao
- Department of Hepatogastroenterology, University Hospital, Caen, France
| | | | | | - Dominique Roulot
- AP-HP, Hôpital Avicenne, Bobigny, France.,University Sorbonne Paris Nord, Bobigny, France
| | - Victor De Ledinghen
- Hepatology Unit, University Hospital Haut Levêque, CHU Bordeaux, Pessac, France
| | - Stanislas Pol
- AP- HP, Hôpital Cochin, Departement d'Hepatologie et INSERM U1016, Université Paris Descartes, Paris, France
| | | | | | - Fabien Zoulim
- Hôpital Hôtel Dieu, Service d'Hepatologie, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hepatologie, et INSERM U1065, Universite de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hepatologie, St Laurent du Var, France
| | - Jean-Marie Peron
- Liver Unit, Universitary Hospital Purpan, University Paul Sabatier III, Toulouse, France
| | | | - Marc Bourliere
- Hôpital Saint Joseph, Service d'Hepatologie, Marseille, France
| | | | | | - Paul Cales
- Liver Unit, University Hospital, Angers, France
| | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hepatologie, Clermont-Ferrand, France
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hepatologie, Creteil, France
| | | | | | - Ghassan Riachi
- Liver Unit, University Hospital Charles-Nicolle, Rouen, France
| | - Laurent Alric
- CHU Toulouse, Service de Medecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hepatologie, Paris, France
| | | | - Christophe Moreno
- Liver Unit, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Attali
- AP-HP, CHU Kremlin-Bicêtre, Service d'Hepatologie, Le Kremlin-Bicêtre, France
| | - Dominique Thabut
- AP-HP, Hôpital La Pitié Salpétrière, Service d'Hepatologie, Paris, France
| | | | | | | | | | | | - Odile Goria
- Liver Unit, University Hospital Charles-Nicolle, Rouen, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hepatologie, Aix-En-Provence, France
| | - Romain Moirand
- University of Rennes, INSERM, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
| | | | | | | | - Jean Henrion
- Liver Unit, University Hospital, Haine Saint-Paul, Belgium
| | | | | | - Xavier Amiot
- AP-HP, Hôpital Tenon, Service d'Hepatologie, Paris, France
| | - Angela Sutton
- AP-HP, Hôpital Avicenne, Bobigny, France.,Inserm, UMR-1138 « Functional Genomics of Solid Tumors », Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Nathalie Barget
- AP-HP, Hôpital Avicenne, Bobigny, France.,Inserm, UMR-1138 « Functional Genomics of Solid Tumors », Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Sylvie Chevret
- SBIM, APHP, Hôpital Saint-Louis, Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Nathalie Ganne-Carrie
- AP-HP, Hôpital Avicenne, Bobigny, France.,University Sorbonne Paris Nord, Bobigny, France.,Inserm, UMR-1138 « Functional Genomics of Solid Tumors », Centre de Recherche des Cordeliers, Université de Paris, Paris, France
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Audureau E, Carrat F, Layese R, Cagnot C, Asselah T, Guyader D, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Chazouillères O, Mallat A, Grangé JD, Attali P, d'Alteroche L, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Pol S, Nahon P. Personalized surveillance for hepatocellular carcinoma in cirrhosis - using machine learning adapted to HCV status. J Hepatol 2020; 73:1434-1445. [PMID: 32615276 DOI: 10.1016/j.jhep.2020.05.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Refining hepatocellular carcinoma (HCC) surveillance programs requires improved individual risk prediction. Thus, we aimed to develop algorithms based on machine learning approaches to predict the risk of HCC more accurately in patients with HCV-related cirrhosis, according to their virological status. METHODS Patients with compensated biopsy-proven HCV-related cirrhosis from the French ANRS CO12 CirVir cohort were included in a semi-annual HCC surveillance program. Three prognostic models for HCC occurrence were built, using (i) Fine-Gray regression as a benchmark, (ii) single decision tree (DT), and (iii) random survival forest for competing risks survival (RSF). Model performance was evaluated from C-indexes validated externally in the ANRS CO22 Hepather cohort (n = 668 enrolled between 08/2012-01/2014). RESULTS Out of 836 patients analyzed, 156 (19%) developed HCC and 434 (52%) achieved sustained virological response (SVR) (median follow-up 63 months). Fine-Gray regression models identified 6 independent predictors of HCC occurrence in patients before SVR (past excessive alcohol intake, genotype 1, elevated AFP and GGT, low platelet count and albuminemia) and 3 in patients after SVR (elevated AST, low platelet count and shorter prothrombin time). DT analysis confirmed these associations but revealed more complex interactions, yielding 8 patient groups with varying cancer risks and predictors depending on SVR achievement. On RSF analysis, the most important predictors of HCC varied by SVR status (non-SVR: platelet count, GGT, AFP and albuminemia; SVR: prothrombin time, ALT, age and platelet count). Externally validated C-indexes before/after SVR were 0.64/0.64 [Fine-Gray], 0.60/62 [DT] and 0.71/0.70 [RSF]. CONCLUSIONS Risk factors for hepatocarcinogenesis differ according to SVR status. Machine learning algorithms can refine HCC risk assessment by revealing complex interactions between cancer predictors. Such approaches could be used to develop more cost-effective tailored surveillance programs. LAY SUMMARY Patients with HCV-related cirrhosis must be included in liver cancer surveillance programs, which rely on ultrasound examination every 6 months. Hepatocellular carcinoma (HCC) screening is hampered by sensitivity issues, leading to late cancer diagnoses in a substantial number of patients. Refining surveillance periodicity and modality using more sophisticated imaging techniques such as MRI may only be cost-effective in patients with the highest HCC incidence. Herein, we demonstrate how machine learning algorithms (i.e. data-driven mathematical models to make predictions or decisions), can refine individualized risk prediction.
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Affiliation(s)
- Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Fabrice Carrat
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH)
| | - Tarik Asselah
- AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy
| | | | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie; INSERM U1052 - CRCL; Université de Lyon, Lyon
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice
| | | | | | | | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse
| | | | | | - Jean-Frédéric Blanc
- Hôpital St André, Service d'Hépatologie, Bordeaux et Hôpital Haut-Lévêque, CHU Bordeaux, 33604 Pessac
| | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | - Olivier Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, and Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, Paris
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | | | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206 Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000, Paris, France.
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Brichler S, Nahon P, Zoulim F, Layese R, Bourcier V, Audureau E, Sutton A, Letouze E, Cagnot C, Marcellin P, Guyader D, Roulot D, Pol S, de Ledinghen V, Zarski JP, Calès P, Tran A, Peron JM, Mallat A, Riachi G, Grange JD, Blanc JF, Bacq Y, Ouzan D, Bronowicki JP, Mathurin P, Larrey D, Alric L, Attali P, Serfaty L, Pilette C, Bourlière M, Thabut D, Silvain C, Wartelle C, Zucman D, Christidis C, Roudot-Thoraval F, Ganne-Carrie N. Non-virological factors are drivers of hepatocellular carcinoma in virosuppressed hepatitis B cirrhosis: Results of ANRS CO12 CirVir cohort. J Viral Hepat 2019; 26:384-396. [PMID: 30380181 DOI: 10.1111/jvh.13029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022]
Abstract
Worldwide, hepatocellular carcinoma (HCC) occurs mainly in Asian patients with hepatitis B virus (HBV) infection. This study aimed to decipher the environmental and virological factors associated with HCC occurrence and validate risk scoring systems in a French multicentre prospective cohort of HBV cirrhotic patients. Patients with biopsy-proven Child-Pugh A viral cirrhosis included in the ANRS CO12 CirVir cohort who were HBsAg(+) without hepatitis C coinfection were selected for: (a) interview through a standardized questionnaire reporting coffee consumption and HCC familial history; (b) HBsAg quantification using baseline and sequential 2-year frozen sera; (c) baseline HBV genotype determination; and (d) assessment of risk factors and applicability of HCC risk scores (Kaplan-Meier analysis, Cox models). Among 317 patients studied (261 men, median age 53 years, past or ongoing antiviral treatment 93.3% and baseline detectable HBV DNA in 88 patients), the baseline and 2-year median HBsAg levels were 810 and 463 IU/mL, respectively. After a median follow-up of 65.2 months, 27 HCC cases were diagnosed (annual incidence: 1.6%). Three factors were independently associated with HCC occurrence: age > 50 years, platelets ≤ 150 × 103 /mm3 and body mass index ≥ 30 kg/m2 . Two out of five risk scores were validated, and the most accurate was PAGE-B at 1 year. Moreover, HCC in patients without maintained virological suppression seems more aggressive and less accessible to curative treatment. In conclusion, in French patients with HBV cirrhosis mostly virally suppressed, independent HCC risk factors were host-related (age, obesity) or linked to the severity of cirrhosis (thrombopenia), and the European PAGE-B score was the most accurate risk score.
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Affiliation(s)
- Segolene Brichler
- AP-HP, Hôpital Avicenne, Microbiologie Clinique, Bobigny, France.,Université Paris 13, Bobigny, France.,INSERM U955, Université Paris-Est, Créteil, France
| | - Pierre Nahon
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Hépatologie, Lyon, France.,INSERM U1052, Université de Lyon, Lyon, France
| | - Richard Layese
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Valerie Bourcier
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Angela Sutton
- APHP, Hôpital Jean-Verdier, Biochimie, Bondy, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | | | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Hépatologie, INSERM UMS20 and U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | | | - Albert Tran
- CHU, Hépatologie, INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri-Mondor, Hépatologie, Créteil, France
| | | | | | | | | | - Denis Ouzan
- Institut Arnaud-Tzanck, Hépatologie, St-Laurent-du-Var, France
| | | | | | | | - Laurent Alric
- CHU, Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Pierre Attali
- AP-HP, Hôpital Paul-Brousse, Hépatologie, Villejuif, France
| | | | | | | | | | | | | | | | | | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France.,AP-HP, Hôpital Henri-Mondor, Hépatologie, Créteil, France
| | - Nathalie Ganne-Carrie
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
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4
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Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Roudot-Thoraval F, Audureau E. Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs. Gastroenterology 2018; 155:1436-1450.e6. [PMID: 30031138 DOI: 10.1053/j.gastro.2018.07.015] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/30/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Retrospective studies have found an unexpectedly high incidence of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV)-associated cirrhosis who received direct-acting antiviral (DAA) agents. We analyzed data from the ANRS CO12 CirVir cohort to compare the incidence of HCC in patients with cirrhosis who received DAA therapy vs patients treated with interferon (IFN). METHODS Data were collected from 1270 patients with compensated biopsy-proven HCV-associated cirrhosis recruited from 2006 through 2012 at 35 centers in France. For descriptive purpose, patients were classified as follows: patients who received DAA treatment (DAA group, n = 336), patients who achieved a sustained virologic response (SVR) following an IFN-based regimen (SVR-IFN group, n = 495), or patients who never received DAA treatment and never had an SVR following IFN therapy (non-SVR group, n = 439). The patients were included in HCC surveillance programs based on ultrasound examination every 6 months, and clinical and biological data were recorded. To account for confounding by indication due to differences in patient characteristics at treatment initiation, we constructed a time-dependent Cox regression model weighted by the inverse probability of treatment and censoring (IPTCW) to assess the treatment effects of DAA on time until HCC. RESULTS Compared with patients in the SVR-IFN group, patients in the DAA group were older, higher proportions had diabetes or portal hypertension, and liver function was more severely impaired. The crude 3-year cumulative incidences of HCC were 5.9% in the DAA group, 3.1% in the SVR-IFN group, and 12.7% in the non-SVR group (overall P < .001; unadjusted hazard ratio [HR] for HCC 2.03; 95% confidence interval [CI] 1.07-3.84; P = .030 for the DAA group vs the SVR-IFN group). HCC characteristics were similar among groups. Among patients with HCC, the DAA group received less-frequent HCC screening than the other 2 groups (P = .002). After Cox analyses weighted by the IPTCW, we found no statistically significant increase in risk of HCC associated with DAA use (HR 0.89; 95% CI 0.46-1.73; P = .73). CONCLUSIONS Analysis of data from the ANRS CO12 CirVir cohort reveals that the apparent increase in HCC incidence observed in patients with cirrhosis treated with DAAs compared with patients who achieved SVR following an IFN therapy can be explained by patient characteristics (age, diabetes, reduced liver function) and lower screening intensity.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer," F-93206 Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides," F-75000, Paris, France.
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord and sud Sida-HIV Hépatites-FRENSH), France
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie, France; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie et Université de Lyon, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice, France; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers, France
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027, Paris, France; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Inserm U1148, Université Paris 13, Bobigny, France
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
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5
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Allaire M, Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, DI Martino V, Sutton A, Letouzé E, Audureau E, Roudot-Thoraval F. Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication. Hepatology 2018; 68:1245-1259. [PMID: 29663511 DOI: 10.1002/hep.30034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Data on extrahepatic cancers (EHCs) in compensated viral cirrhosis are limited. The objective of the prospective multicenter Agence Nationale de Recherche sur le SIDA et les Hépatites virales CO12 CirVir cohort was to assess the occurrence of all clinical events in patients with compensated viral cirrhosis, including all types of cancer. Patients with the following inclusion criteria were enrolled in 35 French centers: (1) biopsy-proven hepatitis B virus (HBV) or hepatitis C virus (HCV) cirrhosis, (2) Child-Pugh A, or (3) absence of previous liver complications including primary liver cancer (PLC). Patients were followed up prospectively every 6 months. The standardized mortality ratio (SMR) was calculated according to age and gender using 5-year periods. The impact of sustained viral response (SVR) in HCV patients and maintained viral suppression in HBV patients were assessed using time-dependent analysis. A total of 1,671 patients were enrolled between 2006 and 2012 (median age, 54.9 years; men, 67.3%; HCV, 1,323; HBV, 317; HCV-HBV, 31). Metabolic features and excessive alcohol and tobacco consumption were recorded in 15.2%, 36.4%, and 56.4% of cases, respectively. After a median follow-up of 59.7 months, 227 PLCs were diagnosed (5-year cumulative incidence [CumI] 13.4%) and 93 patients developed EHC (14 patients with lymphoid or related tissue cancer and 79 with solid tissue cancer; 5-year EHC CumI, 5.9%). Compared to the general French population, patients were younger at cancer diagnosis, with significantly higher risk of EHC in HCV patients (SMR, 1.31; 95 confidence interval [CI], 1.04-1.64; P = 0.017) and after SVR (SMR = 1.57; 95% CI, 1.08-2.22; P = 0.013). EHC was the fourth leading cause of death in the whole cohort and the first in patients with viral control/eradication. CONCLUSION Compared to the general French population, HCV cirrhosis is associated with a higher risk of EHC and the first cause of death in patients with viral cirrhosis who achieve virological control/eradication. (Hepatology 2018).
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Affiliation(s)
- Manon Allaire
- Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France.,Inserm UMR 1149, Centre de recherche sur l'inflammation, Paris, France
| | - Pierre Nahon
- Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France.,Equipe Labellisée Ligue contre le cancer, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.,Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France
| | - Richard Layese
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
| | - Valérie Bourcier
- Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France
| | - Carole Cagnot
- ANRS (France Recherche Nord & sud Sida-hiv Hépatites), Paris, France
| | | | - Dominique Guyader
- Service d'Hépatologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Stanislas Pol
- Service d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.,Inserm MS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Dominique Larrey
- Service d'Hépatologie, Centre Hospitalo-Universitaire Saint Eloi, Montpellier, France.,Liver and Gastroenterology, Department-IRB-INSERM-1183, Bordeaux, France
| | | | - Denis Ouzan
- Service d'Hépatologie, Institut Arnaud Tzanck, Saint Laurent du Var, France
| | - Fabien Zoulim
- Service d'Hépatologie, Hospices Civils de Lyon, Lyon, France
| | | | - Albert Tran
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Nice, Nice, France.,Hepatic Complications in Obesity, Inserm U1065, C3M, Team 8, Nice, France
| | - Jean-Pierre Bronowicki
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - Jean-Pierre Zarski
- Service d'Hépatologie, Centre Hospitalo-Universitaire Michallon, Grenoble, France
| | - Ghassan Riachi
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire Charles-Nicolle, Rouen, France
| | - Paul Calès
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire d'Angers, Angers, France.,Laboratoire HIFIH, UPRES 3859, SFR ICAT 4208, UFR Santé, Université d'Angers, UBL, Angers, France
| | - Jean-Marie Péron
- Service d'Hépatologie, Centre Hospitalo-Universitaire Purpan, Toulouse, France
| | - Laurent Alric
- Service de Médecine Interne, Centre Hospitalo-Universitaire Purpan, Toulouse, France
| | - Marc Bourlière
- Service d'Hépatologie, Hôpital Saint Joseph, Marseille, France
| | - Philippe Mathurin
- Service d'Hépatologie, Centre Hospitalo-Universitaire Claude Huriez, Lille, France
| | - Jean-Frédéric Blanc
- Service d'Hépatologie, Centre Hospitalo-Universitaire Saint André, Bordeaux, France
| | - Armand Abergel
- Service d'Hépatologie, Centre Hospitalo-Universitaire Hôtel Dieu, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Service d'Hépatologie, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Ariane Mallat
- Service d'Hépatologie, AP-HP, Hôpital Henri Mondor, University Paris-Est, Créteil, France.,Inserm, U955, Créteil, France
| | | | - Pierre Attali
- Service d'Hépatologie, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Yannick Bacq
- Service d'Hépatologie, Centre Hospitalo-Universitaire Trousseau, Tours, France
| | - Claire Wartelle
- Service d'Hépatologie, Hôpital d'Aix-en-Provence, Aix-En-Provence, France
| | - Thông Dao
- Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France
| | - Dominique Thabut
- Service d'Hépatologie, AP-HP, Hôpital La Pitié Salpêtrière, Paris, France
| | | | - Christine Silvain
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | | | - Eric Nguyen-Khac
- Service d'Hépatologie, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | | | - David Zucman
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Vincent DI Martino
- Service d'Hépatologie, Centre Hospitalo-Universitaire Jean Minjoz, Besançon, France
| | - Angela Sutton
- Centre de Ressources Biologiques, Groupe Hospitalier Paris, Seine-Saint-Denis, France.,Service de Biochimie, AP-HP, Hôpital Jean Verdier, Bondy, France.,Inserm U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France
| | - Etienne Audureau
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
| | - Françoise Roudot-Thoraval
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
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6
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Costentin CE, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Letouzé E, Imbeaud S, Zucman-Rossi J, Audureau E, Roudot-Thoraval F, Nahon P. Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study. Gastroenterology 2018; 155:431-442.e10. [PMID: 29729258 DOI: 10.1053/j.gastro.2018.04.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Semi-annual surveillance for hepatocellular carcinoma (HCC) is recommended for patients with cirrhosis. We aimed to determine how compliance with HCC surveillance guidelines affects survival times of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis who developed HCC. METHODS We collected data from the prospective ANRS CO12 CirVir study, from March 2006 through June 2012, on 1671 patients with biopsy-proven viral cirrhosis and no previous liver complications who were undergoing surveillance for HCC at 35 centers in France. Only 216 patients who developed HCC during the follow-up period were included in the analysis. Patients were considered to be compliant with surveillance guidelines if the time between their last surveillance image evaluation and diagnosis of HCC were fewer than 7 months and noncompliant if this time was 7 months or longer. RESULTS HCC was detected in 216 patients, at a median follow-up time of 59.7 months. Of these patients, 140 (80.5%) were Barcelona Clinic Liver Cancer stage 0/A, 135 (69.9%) received first-line curative treatment (15 underwent transplantation, 29 underwent resection, 89 received percutaneous ablation, and 2 received resection and percutaneous ablation), and 129 (60.0%) were compliant with surveillance guidelines. Seventy-nine of the patients with HCC died; 49 deaths were associated with tumor progression. After lead-time adjustment, overall survival (OS) time was longer in patients compliant with surveillance guidelines (median OS time, 53.2 months) than noncompliant patients (median OS time, 25.4 months) (P = .0107); this difference remained significant even when we changed lead time assumptions. In multivariate analysis adjusted for a propensity score, compliance with HCC surveillance guidelines was associated with low tumor burden, allocation of curative treatment, and increased OS time compared with noncompliance (hazard ratio for OS, 2.19; 95% confidence interval, 1.16-4.14; P = .0150). CONCLUSIONS In an analysis of data from the ANRS CO12 CirVir cohort, we associated compliance with HCC surveillance guidelines (fewer than 7 months between image evaluations) with early diagnosis, allocation of curative treatment, and longer adjusted OS of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis and a diagnosis of HCC.
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Affiliation(s)
- Charlotte E Costentin
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France.
| | - Richard Layese
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Valérie Bourcier
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord & sud Sida-HIV Hépatites, Paris, France
| | - Patrick Marcellin
- Assistance Publique-Hopitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
| | - Dominique Guyader
- Centre Hospitalier Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France
| | - Stanislas Pol
- Assistance Publique-Hopitaux de Paris, Hôpital Cochin, Département d'Hépatologie et Institut National de la Santé et de la Recherche Médicale, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Département d'Hépatologie, Lyon, France
| | - Dominique Roulot
- Assistance Publique-Hopitaux de Paris, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France
| | - Albert Tran
- Centre Hospitalier Universitaire de Nice, Service d'Hépatologie, et Institut National de la Santé et de la Recherche Médicale, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastroentérologie, Rouen, France
| | - Paul Calès
- Centre Hospitalier Universitaire d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- Centre Hospitalier Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Centre Hospitalier Universitaire Estaing, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Assistance Publique-Hopitaux de Paris, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; L'Université Paris-Est Créteil et Institut National de la Santé et de la Recherche Médicale, Créteil, France
| | - Jean-Didier Grangé
- Assistance Publique-Hopitaux de Paris, Hôpital Tenon, Service d'Hépatologie, Paris, France
| | - Pierre Attali
- Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, Centres Hospitaliers Régionaux et Universitaires de Tours, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- Assistance Publique-Hopitaux de Paris, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Christophe Pilette
- Centre Hospitalier Universitaire Le Mans, Service d'Hépatologie, Le Mans, France
| | - Christine Silvain
- Centre Hospitalier Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France
| | | | | | | | - David Zucman
- Hôpital Foch, Service d'Hépatologie, Suresnes, France
| | | | - Angela Sutton
- Liver Disease Biobank, Groupe Hospitalier Paris Seine-Saint-Denis, France; Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Institut National de la Santé et de la Recherche Médicale U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Sandrine Imbeaud
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Jessica Zucman-Rossi
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France; Assistance Publique-Hopitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Oncologie, Paris, France
| | - Etienne Audureau
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Françoise Roudot-Thoraval
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Pierre Nahon
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
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7
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Cacoub P, Nahon P, Layese R, Blaise L, Desbois AC, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Zucman D, Di Martino V, Bagnis CI, Ziol M, Sutton A, Letouze E, Roudot-Thoraval F, Audureau E. Prognostic value of viral eradication for major adverse cardiovascular events in hepatitis C cirrhotic patients. Am Heart J 2018; 198:4-17. [PMID: 29653647 DOI: 10.1016/j.ahj.2017.10.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective was to examine the role of a sustained virological response (SVR) on major adverse cardiovascular events (MACEs) in patients with compensated hepatitis C virus (HCV) cirrhosis. METHODS Patients with the following criteria were enrolled in 35 French centers: (1) biopsy-proven HCV cirrhosis; (2) Child-Pugh A; (3) positive viremia; and (4) no prior liver complication, and then prospectively followed. All patients received HCV treatment after inclusion. MACEs included stroke, myocardial infarction, ischemic heart disease, heart failure, peripheral arterial disease, cardiac arrest, and cardiovascular death. SVR, defined as negative viremia 12 weeks posttreatment, was considered as a time-dependent covariate, and its effect on MACE occurrence was assessed. The median follow up was 57.5 months, ending in December 2015. RESULTS Sixty-two of 878 (7.1%) patients presented a total of 79 MACEs. The main predictive baseline factors of MACEs were Asian ethnic origin, history of MACEs, arterial hypertension, diabetes mellitus, current smoking, low serum albumin level, high total bilirubin level, and low platelet count. In multivariate analysis, SVR was associated with a decreased risk of MACEs (hazard ratio=0.35, 95% CI 0.09-0.97, P=.044), whereas Asian ethnic origin, arterial hypertension, smoking, and low serum albumin level remained predictive of MACE occurrence. The 5-year survival rate was 60.1% versus 87.5% in patients who did versus those who did not present a MACE (P<.001). CONCLUSIONS In patients with compensated HCV-related cirrhosis, Asian ethnic origin, arterial hypertension, smoking, and low serum albumin are independent predictive factors of cardiovascular events, whereas an SVR is associated with a decreased rate of cardiovascular events.
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Affiliation(s)
- Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
| | | | - Anne Claire Desbois
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENCH)
| | | | | | - Stanislas Pol
- Université Paris Descartes, APHP, Unité d'Hépatologie, Hôpital Cochin, INSERM U-1223 et USM20, Institut Pasteur, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | | | | | - Albert Tran
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France and University Hospital of Nice, Digestive Centre, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastro-entérologie, Rouen
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers
| | | | - Laurent Alric
- Service de Médecine Interne-Pôle Digestif CHU Toulouse, UMR 152, IRD, Toulouse 3 University
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | | | | | - Corinne Isnard Bagnis
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Nephrology, Paris, France
| | - Marianne Ziol
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris; AP-HP, Hôpital Jean Verdier, Service d'Anatomopathologie, Bondy; CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027
| | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy
| | - Eric Letouze
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
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Nahon P, Lescat M, Layese R, Bourcier V, Talmat N, Allam S, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Trinchet JC, Moreau R, Roudot-Thoraval F. Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort). Gut 2017; 66:330-341. [PMID: 26511797 DOI: 10.1136/gutjnl-2015-310275] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/27/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis. DESIGN This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework. RESULTS 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control. CONCLUSION BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Mathilde Lescat
- AP-HP, Hôpital Jean Verdier, Service de Microbiologie, Bondy, Université Paris 13, Bobigny, et INSERM UMR 1139, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, Créteil, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Nabila Talmat
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Setty Allam
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Odile Goria
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Yves Benhamou
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | | | | | | | | | | | | | | | - Jean-Claude Trinchet
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Richard Moreau
- AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
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9
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Nahon P, Bourcier V, Layese R, Audureau E, Cagnot C, Marcellin P, Guyader D, Fontaine H, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Leroy V, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Dharancy S, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Zucman D, Di Martino V, Thibaut V, Salmon D, Ziol M, Sutton A, Pol S, Roudot-Thoraval F, Marcellin P, Guyader D, Pol S, Fontaine H, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Leroy V, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Hillaire S, Di Martino V. Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications. Gastroenterology 2017; 152:142-156.e2. [PMID: 27641509 DOI: 10.1053/j.gastro.2016.09.009] [Citation(s) in RCA: 365] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We performed a prospective study to investigate the effects of a sustained viral response (SVR) on outcomes of patients with hepatitis C virus (HCV) infection and compensated cirrhosis. METHODS We collected data from 1323 patients included in the prospective Agence Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS) viral cirrhosis (CirVir) cohort, recruited from 35 clinical centers in France from 2006 through 2012. All patients had HCV infection and biopsy-proven cirrhosis, were Child-Pugh class A, and had no prior liver complications. All patients received anti-HCV treatment before or after inclusion (with interferon then with direct antiviral agents) and underwent an ultrasound examination every 6 months, as well as endoscopic evaluations. SVR was considered as a time-dependent covariate; its effect on outcome was assessed by the Cox proportional hazard regression method. We used a propensity score to minimize confounding by indication of treatment and capacity to achieve SVR. RESULTS After a median follow-up period of 58.2 months, 668 patients (50.5%) achieved SVR. SVR was associated with a decreased incidence of hepatocellular carcinoma (hazard ratio [HR] compared with patients without an SVR, 0.29; 95% confidence interval [CI], 0.19-0.43; P < .001) and hepatic decompensation (HR, 0.26; 95% CI, 0.17-0.39; P < .001). Patients with SVRs also had a lower risk of cardiovascular events (HR, 0.42; 95% CI, 0.25-0.69; P = .001) and bacterial infections (HR, 0.44; 95% CI, 0.29-0.68; P < .001). Metabolic features were associated with a higher risk of hepatocellular carcinoma in patients with SVRs, but not in patients with viremia. SVR affected overall mortality (HR, 0.27 compared with patients without SVR; 95% CI, 0.18-0.42; P < .001) and death from liver-related and non-liver-related causes. Similar results were obtained in a propensity score-matched population. CONCLUSIONS We confirmed a reduction in critical events, liver-related or not, in a prospective study of patients with HCV infection and compensated cirrhosis included in the CirVir cohort who achieved an SVR. We found an SVR to reduce overall mortality and risk of death from liver-related and non-liver-related causes. A longer follow-up evaluation is required to accurately describe and assess specific risk factors for complications in this population.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, France; Inserm, UMR-1162, "Génomique Fonctionnelle des Tumeur Solides," Paris, France.
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, Association Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS), France REcherche Nord and sud Sida-HIV Hépatites, Paris, France
| | | | - Dominique Guyader
- Centre Hospitalo-Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France
| | | | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie et Université de Lyon, Lyon, France
| | | | - Albert Tran
- Centre Hospitalo-Universitaire de Nice, Service d'Hépatologie, Nice, France; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity," Nice, France
| | - Jean-Pierre Bronowicki
- Inserm 954, Centre Hospitalo-Universitaire de Nancy, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | | | - Vincent Leroy
- Hôpital Michallon, Service d'Hépatologie, Grenoble, France
| | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- Centre Hospitalo-Universitaire d'Angers, Service d'Hépato-Gastroentérologie, Angers, France
| | | | - Laurent Alric
- Centre Hospitalo-Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, Centre Hospitalier Régional Universitaire de Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-en-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Yves Benhamou
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Christophe Pilette
- Centre Hospitalo-Universitaire Le Mans, Service d'Hépatologie, Le Mans, France
| | - Christine Silvain
- Centre Hospitalo-Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France
| | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | | | - Vincent Thibaut
- Centre Hospitalo-Universitaire Pontchaillou, Service de Virologie, Rennes, France
| | - Dominique Salmon
- AP-HP, Hôpital Cochin, Service de Maladies Infectieuses, Université Paris Descartes, Paris, France
| | - Marianne Ziol
- Université Paris 13, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, France; Inserm, UMR-1162, "Génomique Fonctionnelle des Tumeur Solides," Paris, France; AP-HP, Hôpital Jean Verdier, Service d'Anatomopathologie, Bondy, France; Centre de Ressources Biologiques (Liver Disease Biobank) Groupe Hospitalier Paris, Seine-Saint-Denis, France
| | - Angela Sutton
- Centre de Ressources Biologiques (Liver Disease Biobank) Groupe Hospitalier Paris, Seine-Saint-Denis, France; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Inserm U1148, Université Paris 13, Bobigny, France
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie, France; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France
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10
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Ganne-Carrié N, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, de Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Zucman D, Di Martino V, Trinchet JC, Nahon P, Roudot-Thoraval F. Nomogram for individualized prediction of hepatocellular carcinoma occurrence in hepatitis C virus cirrhosis (ANRS CO12 CirVir). Hepatology 2016; 64:1136-47. [PMID: 27348075 DOI: 10.1002/hep.28702] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/13/2016] [Accepted: 06/23/2016] [Indexed: 01/10/2023]
Abstract
UNLABELLED The aim of this work was to develop an individualized score for predicting hepatocellular carcinoma (HCC) in patients with hepatitis C (HCV)-compensated cirrhosis. Among 1,323 patients with HCV cirrhosis enrolled in the French prospective ANRS CO12 CirVir cohort, 720 and 360 were randomly assigned to training and validation sets, respectively. Cox's multivariate model was used to predict HCC, after which a nomogram was computed to assess individualized risk. During follow-up (median, 51.0 months), 103 and 39 patients developed HCC in the training and validation sets, respectively. Five variables were independently associated with occurrence of HCC: age > 50 years (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.16; 3.25; P = 0.012); past excessive alcohol intake (HR, 1.55; 95% CI, 1.02; 2.36; P = 0.041); low platelet count (<100 Giga/mm(3) : HR, 2.70; 95% CI, 1.62; 4.51; P < 0.001; [100; 150] Giga/mm(3) : HR, 1.87; 95% CI, 1.10; 3.18; P = 0.021); gamma-glutamyl transpeptidase above the upper limit of normal (HR, 1.96; 95% CI, 1.11; 3.47; P = 0.021); and absence of a sustained virological response during follow-up (HR, 3.02; 95% CI, 1.67; 5.48; P < 0.001). An 11-point risk score was derived from the training cohort and validated in the validation set. Based on this score, the population was stratified into three groups, in which HCC development gradually increased, from 0% to 30.1% at 5 years for patients with the lowest (≤3) and highest (≥8) scores (P < 0.001). Using this score, a nomogram was built enabling individualized prediction of HCC occurrence at 1, 3, and 5 years. CONCLUSION This HCC score can accurately predict HCC at an individual level in French patients with HCV cirrhosis. (Hepatology 2016;64:1136-1147).
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Affiliation(s)
- Nathalie Ganne-Carrié
- AP-HP, Hospital Jean Verdier, Liver Unit, Bondy, France. .,University Paris 13, Sorbonne Paris Cité, Paris, France. .,Inserm, UMR-1162 "Genomic alterations in liver tumors", F-75010, Paris, France.
| | - Richard Layese
- AP-HP, Hospital Henri Mondor, Department of Public Health, Créteil, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & Sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Patrick Marcellin
- AP-HP, Hospital Beaujon, Liver Unit, Clichy and University Paris 7, Paris, France
| | | | - Stanislas Pol
- University Paris Descartes, APHP, Liver Unit, Hospital Cochin; INSERM U-818 and USM20, Institut Pasteur, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Liver Unit, St. Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Liver Unit, University and INSERM U1052, Lyon, France
| | - Dominique Roulot
- University Paris 13, Sorbonne Paris Cité, Paris, France.,AP-HP, Hospital Avicenne, Liver Unit, Bobigny, France
| | - Albert Tran
- University Hospital of Nice, Liver Unit, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity," F-06204, Cedex 3, Nice, France
| | - Jean-Pierre Bronowicki
- Inserm 954, Universitary Hospital of Nancy, University of Lorraine, Vandoeuvre-les-Nancy, France
| | - Jean-Pierre Zarski
- Clinic of Hepato-Gastroenterology, Digidune pole, University Hospital, Grenoble, France
| | | | - Paul Calès
- University Hospital, Liver Unit and University Bretagne-Loire, Angers, France
| | - Jean-Marie Péron
- Hospital Purpan, Liver Unit and University Paul Sabatier III, Toulouse, France
| | - Laurent Alric
- University Hospital, Internal Medicine Unit - Digestive pole UMR 152, Toulouse, France
| | | | | | | | - Armand Abergel
- Hospital Hôtel Dieu, Liver Unit, Clermont-Ferrand, France
| | | | - Ariane Mallat
- AP-HP, Hospital Henri Mondor, Liver Unit, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hospital Paul Brousse, Liver Unit, Villejuif, France
| | | | - Claire Wartelle
- Hospital of Aix-En-Provence, Liver Unit, Aix-En-Provence, France
| | - Thông Dao
- Hospital Côte de Nacre, Liver Unit, Caen, France
| | - Yves Benhamou
- AP-HP, Pitié-Salpêtrière Hospital, Liver Unit, Paris, France
| | | | | | | | | | | | - David Zucman
- Hospital Foch, Internal Medicine, Suresnes, France
| | | | - Jean-Claude Trinchet
- AP-HP, Hospital Jean Verdier, Liver Unit, Bondy, France.,University Paris 13, Sorbonne Paris Cité, Paris, France.,Inserm, UMR-1162 "Genomic alterations in liver tumors", F-75010, Paris, France
| | - Pierre Nahon
- AP-HP, Hospital Jean Verdier, Liver Unit, Bondy, France.,University Paris 13, Sorbonne Paris Cité, Paris, France.,Inserm, UMR-1162 "Genomic alterations in liver tumors", F-75010, Paris, France
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11
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Trinchet JC, Bourcier V, Chaffaut C, Ait Ahmed M, Allam S, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Buffet C, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Hillaire S, Di Martino V, Nahon P, Chevret S. Complications and competing risks of death in compensated viral cirrhosis (ANRS CO12 CirVir prospective cohort). Hepatology 2015; 62:737-50. [PMID: 25678021 DOI: 10.1002/hep.27743] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/02/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Various critical events, liver related or not, occur in patients with compensated cirrhosis, but their respective burden remains to be prospectively assessed. The aim of this prospective cohort study involving 35 French centers was to capture the whole spectrum of complications occurring in compensated viral cirrhosis (VC) using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis resulting from hepatitis C virus (HCV) or hepatitis B virus (HBV); Child-Pugh A; and no previous hepatic complications. The cohort was considered as a multistate disease model, cumulative incidences (CumIs) of events were estimated in a competing risks framework. A total of 1,654 patients were enrolled from 2006 to 2012 (HCV, 1,308; HBV, 315; HCV-HBV, 31). During a median follow-up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4-year cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4-year cumI: 11.4% vs. 7.4%; P = 0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4-year cumI: 10.8% vs. 3.6%; P = 0.0004). Virological eradication/control was achieved in 34.1% of HCV and 88.6% of HBV patients and was associated with a marked decrease in HCC, decompensation, and bacterial infection incidences. Survival was shorter in HCV patients (4-year cumI: 91.6% vs. 97.2%; P = 0.0002). Death (n = 102; missing data: 6) was attributed to liver disease in 48 (47%; liver cancer: n = 18; miscellaneous, n = 30) and extrahepatic causes in 48 (47%; bacterial infection: n = 13; extrahepatic cancers: n = 10; cardiovascular events: n = 5; miscellaneous, n = 20). CONCLUSION After 3 years of follow-up, extrahepatic events still explained half of deaths in patients with compensated VC. A strong decrease in complications was linked to virological eradication/control.
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Affiliation(s)
- Jean-Claude Trinchet
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Cendrine Chaffaut
- AP-HP, Hôpital Saint-Louis, SBIM, Université Paris Diderot, Inserm UMR 1153, Paris, France
| | - Mohand Ait Ahmed
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Setty Allam
- ANRS (Agence Nationale de Recherche sur le SIDA et les hépatites virales), Paris, France
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM U1016, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Odile Goria
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Catherine Buffet
- AP-HP, CHU Kremlin-Bicêtre, Service d'Hépatologie, Le Kremlin-Bicêtre, France
| | - Yannick Bacq
- Hôpital Trousseau, Service d'Hépatologie, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Yves Benhamou
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | | | | | | | | | - Gérard Thiefin
- Hôpital Robert Debré, Service d'Hépatologie, Reims, France
| | | | | | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Sylvie Chevret
- AP-HP, Hôpital Saint-Louis, SBIM, Université Paris Diderot, Inserm UMR 1153, Paris, France
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Halfon P, Bourliere M, Ouzan D, Maor Y, Renou C, Wartelle C, Pénaranda G, Tran A, Botta D, Oules V, Castellani P, Portal I, Argiro L, Dessein A. A single IL28B genotype SNP rs12979860 determination predicts treatment response in patients with chronic hepatitis C Genotype 1 virus. Eur J Gastroenterol Hepatol 2011; 23:931-5. [PMID: 21900787 DOI: 10.1097/meg.0b013e328349d0ef] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies have suggested that host genetics may be useful for predicting drug response and have supported the recommendation that single polynucleotide polymorphisms (SNPs) of IL28B should be investigated when treating hepatitis C virus (HCV)-1 infected patients. The aim of this study was to determine whether a single IL-28B genotype SNP rs8099917 or rs12979860 determination is sufficient to predict treatment failure in patients with chronic HCV. METHODS A total of 198 patients were included; mean (±standard deviation) age was 47±12 years and 140 (71%) were men. One hundred and fifty-six (79%) patients were infected with HCV genotype 1 and 42 (21%) with HCV genotypes 2 or 3. One hundred and eight (55%) patients had sustained virologic response (SVR). Two SNPs in the IL-28B were analyzed (rs8099917 and rs12979860). RESULTS A total of 115 (58%) patients had rs8099917 TT genotype and 61 (31%) had rs12979860 CC genotype. Rs8099917 TT and rs12979860 CC genotypes were associated with SVR in HCV genotype 1 patients [odds ratio=2.60 (1.36-5.00), P=0.004 and odds ratio=3.30 (1.58-6.90), P=0.03 respectively]. No association was found between SNPs and SVR in HCV genotype 2 or 3 patients. CONCLUSION This study confirms that SNPs rs8099917 and rs12979860 used alone may be useful for predicting the outcome of HCV treatment. In a rational and cost-effective approach, determination of only one of these two SNPs is sufficient for predicting SVR. Because of the highest predictive SVR associated with rs12979860 CC compared with the rs8099917 TT (respective positive predictive value: 72% vs. 63%, P=ns), rs12979860 determination alone is sufficient for predicting interferon response.
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Halfon P, Pénaranda G, Carrat F, Bedossa P, Bourlière M, Ouzan D, Renou C, Tran A, Rosenthal E, Wartelle C, Delasalle P, Cacoub P. Influence of insulin resistance on hepatic fibrosis and steatosis in hepatitis C virus (HCV) mono-infected compared with HIV-HCV co-infected patients. Aliment Pharmacol Ther 2009; 30:61-70. [PMID: 19292832 DOI: 10.1111/j.1365-2036.2009.03995.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Insulin resistance (IR), the major feature of the metabolic syndrome, is also common in patients with chronic HCV infection. Liver fibrosis and steatosis are known potential outcome of chronic hepatitis B or C infection. Studies have shown that HIV positive individuals co-infected with HCV have more rapid live disease progression than those with HIV alone. Few data have reported the influence of IR on steatosis and fibrosis in the context of HIV-HCV coinfection. AIM To test the association among insulin resistance (IR), liver fibrosis and liver steatosis in HIV-HCV and HCV-infected patients. PATIENTS AND METHODS A total of 170 HIV-HCV-infected patients matched by age, gender and genotype with 170 HCV mono-infected patients were included. Patients were considered to be IR when the homeostasis model assessment of IR >2. Significant fibrosis was considered if METAVIR >or=F2 and significant steatosis if >or=10%. RESULTS Insulin resistance was independently associated in HCV patients with fibrosis [odds ratio (OR) = 2.04 (95% CI 1.02-4)], a body mass index (BMI) >25 kg/m(2) [OR = 3.33 (1.47-7.69)] and steatosis [OR = 3.33 (1.67-6.67)]. Fibrosis >or=F2 was associated in HCV patients with high liver activity grade (>or=A2) [OR = 8.33 (3.85-16.67)], male gender [OR = 3.03 (1.33-7.14)] and IR [OR = 2.44 (1.15-5)]. In HIV-HCV patients, >or=A2 [OR = 5.56 (1.64-20)] was associated with fibrosis. Steatosis >or=10% was associated in HCV patients with IR [OR = 3.13 (1.59-6.25) and >or=F2 (OR = 2.22 (1.15-4.17)]. In HIV-HCV, a BMI >25 kg/m(2) [OR = 3.85 (1.64-9.10)], >or=A2 [OR = 2.16 (1.02-4.55); P = 0.044] and nucleoside reverse transcriptase inhibitor [OR = 3.61 (1.19-10.96); P = 0.023] were independently associated with significant liver steatosis. CONCLUSIONS Insulin resistance is associated with liver fibrosis and steatosis in HCV mono-infected, but not in HIV-HCV co-infected patients. Significant liver fibrosis is associated with IR independent of liver steatosis only in HCV mono-infected patients.
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Affiliation(s)
- P Halfon
- Laboratoire Alphabio, Marseille, France.
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Abstract
In 2007, the << Haute Autorité de Santé >> recommended FibroScan, FibroTest or liver biopsy for the initial diagnosis of fibrosis in patients with hepatitis C without co morbidities. These methods have to be interpreted according to the clinical situation, keeping in mind negative and positive false results. For FibroTest, hemolysis, Gilbert syndrome or acute inflammation can modify the result. Pre-analytical and analytical conditions of FibroTest have to be respected according to manufactory recommendations. For FibroScan, the numbers of measurements, the rate of successful measurements, and the interquartile range have to be correct. In case of suspicious results, FibroTest or FibroScan have to be done again. The liver biopsy, FibroTest, and FibroScan are less relevant for the distinction of two adjacent stages of fibrosis. However, their performances are excellent for the diagnosis of severe fibrosis or cirrhosis compared to moderate fibrosis.
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Affiliation(s)
- V de Lédinghen
- Centre d'investigation de la Fibrose hépatique, CHU Bordeaux, Hôpital du Haut-Lévêque, 1, avenue de Magellan, 33604 Pessac, France.
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Wartelle C, Viruela PM, Viruela R, Ortí E, Sauvage FX, Levillain E, Le Derf F, Sallé M. A Study by Spectroelectrochemical FTIR and Density Functional Theory Calculations of the Reversible Complexing Ability of an Electroactive Tetrathiafulvalene Crown. J Phys Chem A 2005; 109:1188-95. [PMID: 16833429 DOI: 10.1021/jp045397y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report on the study of the electrochemically targeted complexation/expulsion of a metal cation (Ba2+) by a crown ether tetra(thiomethyl)tetrathiafulvalene derivative (crown-TTM-TTF). Real time, in situ FTIR spectroelectrochemistry was used to obtain spectroscopic evidence of this electrochemically triggered phenomenon. Density functional theory calculations allowed the spectral information collected to be assigned. Both experimental and theoretical results clearly show that neutral crown-TTM-TTF complexes well Ba2+. Complexation is evidenced by a significant downshift of the frequency corresponding to the asymmetric stretching of the C-O-C ether groups. Concerning the cation crown-TTM-TTF, the spectroscopic signal of the complex form was difficult to identify, first because of the rather low value of the complexation constant and second because the vibration modes involving the oxygen atoms (which are the most affected by the complexation) were found by calculation to occur in the lower spectral region (<1000 cm(-1)), which is not accessible in our experimental conditions. In the case of the dication crown-TTM-TTF, it is now clear that the complex form does not exist, which means that the electrochemical formation of the dication necessarily involves the expulsion of the barium ion.
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Affiliation(s)
- C Wartelle
- LASIR-HEI, UMR CNRS 8516, 13 rue de Toul, F-59046 Lille Cedex, France
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Vivien C, Wartelle C, Mutel B, Grimblot J. Surface property modification of a polyethylene powder by coupling fluidized bed and far cold remote nitrogen plasma technologies. SURF INTERFACE ANAL 2002. [DOI: 10.1002/sia.1363] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wartelle C, Bladou F, Delpero JR, Houvenaeghel G, Monges G, Seitz JF, Giovannini M, Guerinel G. [Mucinous cystadenocarcinoma of the appendix. A rare tumor of the right iliac fossa]. J Chir (Paris) 1990; 127:459-63. [PMID: 2262520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An observation of a mucinous cystadenocarcinoma of the appendix, in the tumor form, revealed by a painful syndrome of the right iliac fossa in a 62-year man is reported. It is a rare malignant tumor as less than 0.5% of the appendicectomy parts present a malignant mucosecreting tumor. In our observation, the diagnosis was allowed by pre-operation imaging. An increase of the serous amount in the tumor markers (carcinoembryonic antigen) (CEA) and CA 19-9 was found before the intervention and the immunodetections performed on the operation part were positive for CEA and CA 19-9. The serous amounts of these markers were normalized after operation. To the author's knowledge, the interest of dosing the serous tumor markers in the observation of such a type of tumor is not mentioned in the literature. The recurrences are frequent and sometimes late even when the initial excision has been macroscopically satisfactory. A new increase of the serous amount of the markers could allow for an earlier detection of a recurrence during the patient follow-up. At present, the prognosis of these malignant forms remains very poor as the 5-year survival does not exceed 25%.
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Affiliation(s)
- C Wartelle
- Service de Gastroentérologie, Institut J. Paoli et I. Calmettes, Marseille
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