Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study - Université de Rennes Accéder directement au contenu
Article Dans Une Revue Gastroenterology Année : 2018

Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study

1 CHU Henri Mondor [Créteil]
2 CEpiA - Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique
3 Hôpital Jean Verdier [AP-HP]
4 ANRS France Recherche Nord & sud Sida-hiv hépatites
5 Service d’Hépatologie [Hôpital Beaujon]
6 NuMeCan - Nutrition, Métabolismes et Cancer
7 Inserm U1223 - Physiopathologie du système immunitaire
8 Département d'hépatologie [CHU Cochin]
9 UPD5 - Université Paris Descartes - Paris 5
10 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
11 Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi]
12 Hôpital Haut-Lévêque [CHU Bordeaux]
13 Institut Arnault Tzanck
14 HCL - Hospices Civils de Lyon
15 Service de Gastro-entérologie [Avicenne]
16 C3M - Centre méditerranéen de médecine moléculaire
17 Service d'Hépato-gastro-entérologie [CHRU Nancy]
18 Département d'hépato-gastroentérologie
19 INSERM U823 - Institut d'oncologie/développement Albert Bonniot de Grenoble
20 Service d'Hépato-Gastroentérologie [CHU Rouen]
21 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
22 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
23 UT3 - Université Toulouse III - Paul Sabatier
24 PHARMA-DEV - Pharmacochimie et Biologie pour le Développement
25 Service d'hépatologie et de gastroentérologie [Hôpital Saint-Joseph - Marseille]
26 Hôpital Claude Huriez [Lille]
27 LIRIC - Lille Inflammation Research International Center - U 995
28 Physiopathologie du cancer du foie
29 IP - Institut Pascal
30 UCA [2017-2020] - Université Clermont Auvergne [2017-2020]
31 CNRS - Centre National de la Recherche Scientifique
32 CHU Saint-Antoine [AP-HP]
33 UMR INSERM U955
34 UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12
35 Inserm U955 - Molecular virology and immunology – Physiopathology and therapeutic of chronic viral hepatitis (Team 18)
36 CHU Tenon [AP-HP]
37 Onxeo S.A.
38 Département d'Hépato-Gastroentérologie [Hôpital Trousseau, Tours]
39 CHIAP - Centre Hospitalier d'Aix en Provence [Aix-en-Provence]
40 Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]
41 CHU Pitié-Salpêtrière [AP-HP]
42 Centre Hospitalier Le Mans (CH Le Mans)
43 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
44 Hellenic Open University [Patras]
45 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
46 Hôpital universitaire Robert Debré [Reims]
47 Hôpital Foch [Suresnes]
48 Service d'Hépatologie [CHRU Besançon]
49 U1162 - Génomique Fonctionnelle des Tumeurs Solides
50 IUH - Institut Universitaire d'Hématologie
51 UP13 - Université Paris 13
52 HEGP - Hôpital Européen Georges Pompidou [APHP]
53 Service de santé publique [Mondor]
Charlotte Costentin
Denis Ouzan
Fabien Zoulim
Lawrence Serfaty
Pierre Attali
  • Fonction : Auteur
Christos Christidis
David Zucman
Eric Letouzé
Pierre Nahon

Résumé

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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Dates et versions

hal-02648451 , version 1 (29-05-2020)

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Citer

Charlotte Costentin, Richard Layese, Valérie Bourcier, Carole Cagnot, Patrick Marcellin, et al.. 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 (2), pp.431-442.e10. ⟨10.1053/j.gastro.2018.04.027⟩. ⟨hal-02648451⟩
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