Non-virological factors are drivers of Hepatocellular Carcinoma in virosuppressed Hepatitis B cirrhosis: results of ANRS CO12 CirVir cohort.
Fiche publication
Date publication
octobre 2018
Journal
Journal of viral hepatitis
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BRONOWICKI Jean-Pierre
Tous les auteurs :
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,
Lien Pubmed
Résumé
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 multicenter 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 co-infection were selected for: i) interview through a standardized questionnaire reporting coffee consumption and HCC familial history; ii) HBsAg quantification using baseline and sequential two-year frozen sera; iii) baseline HBV genotype determination; and iv) 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 x 10 /mm and body mass index ≥30 kg/m . Two out of five risk scores were validated, and the most accurate was PAGE-B at one year. Moreover, HCC in patients without maintained virological suppression seem 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. This article is protected by copyright. All rights reserved.
Mots clés
ANRS CO12 CirVir, carcinogenesis, prognosis, risk score, viral cirrhosis
Référence
J. Viral Hepat.. 2018 Oct 31;: