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
* Corresponding author
6 CRESS - U1153 - Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé
UPD7 - Université Paris Diderot - Paris 7, CRESS (U1153 / UMR_A 1125) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
Abstract : 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%.
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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, Elsevier, 2018, 69 (6), pp.1274-1283. ⟨10.1016/j.jhep.2018.07.022⟩. ⟨hal-01880156⟩

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