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

Charlotte Costentin 1 Richard Layese 2 Valérie Bourcier 3 Carole Cagnot 4 Patrick Marcellin 5 Dominique Guyader 6 Stanislas Pol 7, 8, 9 Dominique Larrey 10, 11 Victor de Ledinghen 12 Denis Ouzan 13 Fabien Zoulim 14 Dominique Roulot 15 Albert Tran 16 Jean-Pierre Bronowicki 17 Jean-Pierre Zarski 18, 19 Ghassan Riachi 20 P. Calès 21 Jean-Marie Péron 22, 23 Laurent Alric 24 Marc Bourlière 25 Philippe Mathurin 26 Jean-Frédéric Blanc 27, 28 Armand Abergel 29, 30, 31, 32, 33, 34 Lawrence Serfaty 35 Ariane Mallat 36, 37, 38 Jean-Didier Grangé 39 Pierre Attali 40 Yannick Bacq 41 Claire Wartelle Thong Dao 42 Dominique Thabut 43 Christophe Pilette Christine Silvain 44 Christos Christidis 45 Eric Nguyen-Khac 46 Brigitte Bernard-Chabert 47 David Zucman 48 Vincent Di Martino 49 Angela Sutton 3 Eric Letouzé 50 Sandrine Imbeaud 50 Jessica Zucman-Rossi 50, 51, 52, 53, 54 Etienne Audureau 55, 2 Françoise Roudot-Thoraval 55 Pierre Nahon 50
1 CHU Henri Mondor
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 Physiopathologie du système immunitaire
8 Département d'hépatologie [CHU Cochin]
9 UPD5 - Université Paris Descartes - Paris 5
10 CHU Saint-Eloi
11 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
12 Hôpital Haut-Lévêque - Centre d'investigation de la fibrose hépatique [CHU de 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 Hôpital Purpan [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
27 Physiopathologie du cancer du foie
28 Hôpital Haut-Lévêque [CHU Bordeaux]
29 UMR 6602
30 UCA - Université Clermont Auvergne
31 CNRS - Centre National de la Recherche Scientifique
32 SIGMA Clermont
33 Hépatologie Gastro-Entérologie
34 IP - Institut Pascal - Clermont Auvergne
35 Service d'hépatologie [Saint-Antoine]
36 IMRB - Institut Mondor de Recherche Biomédicale
37 UMR INSERM U955
38 UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12
39 CHU Tenon [APHP]
40 Onxeo S.A.
41 Département d'hépato-gastro-entérologie [Hôpital Trousseau : CHRU Tours]
42 Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]
43 Service d'Hépato-Gastroentérologie [CHU Pitié-Salpêtrière]
44 CHU Poitiers - Centre hospitalier universitaire de Poitiers
45 Hellenic Open University [Patras]
46 Service d'Hépato-gastroentérologie [CHU Amiens-Picardie]
47 CHU Reims - Centre Hospitalier Universitaire de Reims
48 SMI - Service de Médecine Interne [Hôpital Foch, Suresnes]
49 Service d'Hépatologie, Hôpital Jean Minjoz, Centre Hospitalier Universitaire de Besançon, Université de Franche Comté
50 U1162 - Génomique Fonctionnelle des Tumeurs Solides
51 Labex Immuno-oncology
52 IUH - Institut Universitaire d'Hématologie
53 UP13 - Université Paris 13
54 HEGP - Hôpital Européen Georges Pompidou [APHP]
55 Service de santé publique [Mondor]
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.

Keywords : Antiviral Agents Carcinoma Hepatocellular Early Detection of Cancer Hepacivirus Guideline Adherence France Follow-Up Studies Female Multivariate Analysis Practice Guidelines as Topic Prospective Studies hepatitis B virus Humans Kaplan-Meier Estimate Liver Liver Cirrhosis Liver neoplasms Male Middle Aged Aged
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https://hal.univ-angers.fr/hal-02648451
Contributeur : Okina Université d'Angers <>
Soumis le : vendredi 29 mai 2020 - 09:36:03
Dernière modification le : vendredi 16 octobre 2020 - 03:33:04

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UNIV-ANGERS | UNIV-TLSE3 | HCL | U823 | UNIV-FCOMTE | IMRB | INSTITUT_PASCAL | UPEC-UPEM | UPEC | UNIV-RENNES1 | SIGMA-CLERMONT | INC-CNRS | NUMECAN | COMUE-NORMANDIE | UNIV-MONTPELLIER | UNICE | UNIV-COTEDAZUR | UNIROUEN | UNIV-AMU | UNICAEN | CNRS | NUMECAN-EXPRES | UNIV-PARIS13 | PRES_CLERMONT | BS | UNIV-PARIS5 | UNIV-PARIS7 | HIFIH | UR1-UFR-SVE | UNIV-RENNES | USPC | SORBONNE-UNIVERSITE | UGA | UNIV-PARIS | SU-MEDECINE | INRAE

Citation

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, WB Saunders, 2018, 155 (2), pp.431-442.e10. ⟨10.1053/j.gastro.2018.04.027⟩. ⟨hal-02648451⟩

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