Estimate of hepatocellular carcinoma incidence in patients with alcoholic cirrhosis

Nathalie Ganne-Carrié (1, 2, 3, 4, 5) , Cendrine Chaffaut (6) , Valérie Bourcier (2) , Isabelle Archambeaud (7) , Jean-Marc Perarnau (8) , Fréderic Oberti (9) , Dominique Roulot (10) , Christophe Moreno (11) , Alexandre Louvet (12) , Thông Dao (13) , Romain Moirand (14) , Odile Goria (15) , Eric Nguyen-Khac (16) , Nicolas Carbonell (17) , Térésa Antonini (18) , Stanislas Pol (19, 20, 21, 10, 22, 23) , Victor de Ledinghen (24) , Violaine Ozenne (25) , Jean Henrion (26) , Jean-Marie Péron (27, 28) , Albert Tran (29) , Gabriel Perlemuter (30) , Xavier Amiot (31) , Jean-Pierre Zarski (32) , Michel Beaugrand (10) , Sylvie Chevret (6)

1 U1162 - Génomique Fonctionnelle des Tumeurs Solides
2 Hôpital Jean Verdier [AP-HP]
3 UP13 - Université Paris 13
4 USPC - Université Sorbonne Paris Cité
5 Ligue Nationale Contre le Cancer - Paris
6 CRESS - U1153 - Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé
7 CHU Nantes - Centre hospitalier universitaire de Nantes
8 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
9 CHU Angers - Centre Hospitalier Universitaire d'Angers
10 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
11 CUB Hôpital Erasme - Unité d'Hématologie [Bruxelles, Belgium]
12 Unité d'Hématologie [CHRU Lille]
13 Laboratoire d'Hématologie Biologique [CHU Caen]
14 NuMeCan - Nutrition, Métabolismes et Cancer
15 CHU Rouen
16 CHU Amiens-Picardie
17 CHU Saint-Antoine [AP-HP]
18 Hôpital Paul Brousse
19 Immunobiologie des Cellules dendritiques
20 UPD5 - Université Paris Descartes - Paris 5
21 Département d'hépatologie [CHU Cochin]
22 Hôpital Cochin [AP-HP]
23 IP - Institut Pasteur [Paris]
24 Hôpital Haut-Lévêque [CHU Bordeaux]
25 Hôpital Lariboisière-Fernand-Widal [APHP]
26 Unité d'Hématologie [CH de Jolimont-Lobbes, Belgium]
27 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
28 UT3 - Université Toulouse III - Paul Sabatier
29 C3M - Centre méditerranéen de médecine moléculaire
30 AP-HP - Hôpital Antoine Béclère [Clamart]
31 CHU Tenon [AP-HP]
32 CHU Grenoble

BACKGROUND & AIMS: More than 90% of cases of hepatocellular carcinoma (HCC) occur in patients with cirrhosis, of which alcohol is a major cause. The CIRRAL cohort aimed to assess the burden of complications in patients with alcoholic cirrhosis, particularly the occurrence of HCC.METHODS: Patients with biopsy-proven compensated alcoholic cirrhosis were included then prospectively followed. The main endpoint was the incidence of HCC. Secondary outcomes were incidence of hepatic focal lesions, overall survival (OS), liver-related mortality and event-free survival (EFS).RESULTS: From October 2010 to April 2016, 652 patients were included in 22 French and Belgian centers. During follow-up (median 29 months), HCC was diagnosed in 43 patients. With the limitation derived from the uncertainty of consecutive patients' inclusion and from a sizable proportion of dropouts (153/652), the incidence of HCC was 2.9 per 100 patient-years, and one- and two-year cumulative incidences of 1.8% and 5.2%, respectively. Although HCC fulfilled the Milan criteria in 33 cases (77%), only 24 patients (56%) underwent curative treatment. An explorative prognostic analysis showed that age, male gender, baseline alpha-fetoprotein, bilirubin and prothrombin were significantly associated with the risk of HCC occurrence. Among 73 deaths, 61 had a recorded cause and 27 were directly attributable to liver disease. At two years, OS, EFS and cumulative incidences of liver-related deaths were 93% (95% CI 90.5-95.4), 80.3% (95% CI 76.9-83.9), and 3.2% (95% CI 1.6-4.8) respectively.CONCLUSION: This large prospective cohort incompletely representative of the whole population with alcoholic cirrhosis showed: a) an annual incidence of HCC of up to 2.9 per 100 patient-years, suggesting that surveillance might be cost effective in these patients; b) a high proportion of HCC detected within the Milan criteria, but only one-half of detected HCC cases were referred for curative treatments; c) a two-year mortality rate of up to 7%.

Keywords: HCC; Compensated cirrhosis; Alcoholic liver disease; Competing risk analysis

Domains: Life Sciences [q-bio]; Human health and pathology; Hépatology and Gastroenterology; Life Sciences [q-bio]; Cancer; Life Sciences [q-bio]; Santé publique et épidémiologie

Nathalie Ganne-Carrié, Cendrine Chaffaut, Valérie Bourcier, Isabelle Archambeaud, Jean-Marc Perarnau, et al.. Estimate of hepatocellular carcinoma incidence in patients with alcoholic cirrhosis. Journal of Hepatology, 2018, 69 (6), pp.1274-1283. ⟨10.1016/j.jhep.2018.07.022⟩. ⟨hal-01880156⟩