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Hepatology. 2018 Oct;68(4):1245-1259. doi: 10.1002/hep.30034. Epub 2018 Jul 10.

Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication.

Author information

1
Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France.
2
Inserm UMR 1149, Centre de recherche sur l'inflammation, Paris, France.
3
Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France.
4
Equipe Labellisée Ligue contre le cancer, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
5
Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France.
6
Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France.
7
ANRS (France Recherche Nord & sud Sida-hiv Hépatites), Paris, France.
8
Service d'Hépatologie, AP-HP, Hôpital Beaujon, Clichy, France.
9
Service d'Hépatologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France.
10
Service d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.
11
Inserm MS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France.
12
Service d'Hépatologie, Centre Hospitalo-Universitaire Saint Eloi, Montpellier, France.
13
Liver and Gastroenterology, Department-IRB-INSERM-1183, Bordeaux, France.
14
Service d'Hépatologie, Hôpital Haut-Lévêque, Bordeaux, France.
15
Service d'Hépatologie, Institut Arnaud Tzanck, Saint Laurent du Var, France.
16
Service d'Hépatologie, Hospices Civils de Lyon, Lyon, France.
17
Service d'Hépatologie, AP-HP, Hôpital Avicenne, Bobigny, France.
18
Service d'Hépatologie, Centre Hospitalo-Universitaire de Nice, Nice, France.
19
Hepatic Complications in Obesity, Inserm U1065, C3M, Team 8, Nice, France.
20
Service d'Hépatologie, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-les-Nancy, France.
21
Service d'Hépatologie, Centre Hospitalo-Universitaire Michallon, Grenoble, France.
22
Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire Charles-Nicolle, Rouen, France.
23
Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire d'Angers, Angers, France.
24
Laboratoire HIFIH, UPRES 3859, SFR ICAT 4208, UFR Santé, Université d'Angers, UBL, Angers, France.
25
Service d'Hépatologie, Centre Hospitalo-Universitaire Purpan, Toulouse, France.
26
Service de Médecine Interne, Centre Hospitalo-Universitaire Purpan, Toulouse, France.
27
Service d'Hépatologie, Hôpital Saint Joseph, Marseille, France.
28
Service d'Hépatologie, Centre Hospitalo-Universitaire Claude Huriez, Lille, France.
29
Service d'Hépatologie, Centre Hospitalo-Universitaire Saint André, Bordeaux, France.
30
Service d'Hépatologie, Centre Hospitalo-Universitaire Hôtel Dieu, Clermont-Ferrand, France.
31
Service d'Hépatologie, AP-HP, Hôpital Saint Antoine, Paris, France.
32
Service d'Hépatologie, AP-HP, Hôpital Henri Mondor, University Paris-Est, Créteil, France.
33
Inserm, U955, Créteil, France.
34
Service d'Hépatologie, AP-HP, Hôpital Tenon, Paris, France.
35
Service d'Hépatologie, AP-HP, Hôpital Paul Brousse, Villejuif, France.
36
Service d'Hépatologie, Centre Hospitalo-Universitaire Trousseau, Tours, France.
37
Service d'Hépatologie, Hôpital d'Aix-en-Provence, Aix-En-Provence, France.
38
Service d'Hépatologie, AP-HP, Hôpital La Pitié Salpêtrière, Paris, France.
39
Service d'Hépatologie, Hôpital Le Mans, Le Mans, France.
40
Service d'Hépatologie, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France.
41
Service d'Hépatologie, Intitut Mutualiste Montsouris, Paris, France.
42
Service d'Hépatologie, Centre Hospitalo-Universitaire d'Amiens, Amiens, France.
43
Service d'Hépatologie, Centre Hospitalo-Universitaire Robert Debré, Reims, France.
44
Service de Médecine Interne, Hôpital Foch, Suresnes, France.
45
Service d'Hépatologie, Centre Hospitalo-Universitaire Jean Minjoz, Besançon, France.
46
Centre de Ressources Biologiques, Groupe Hospitalier Paris, Seine-Saint-Denis, France.
47
Service de Biochimie, AP-HP, Hôpital Jean Verdier, Bondy, France.
48
Inserm U1148, Université Paris 13, Bobigny, France.

Abstract

Data on extrahepatic cancers (EHCs) in compensated viral cirrhosis are limited. The objective of the prospective multicenter Agence Nationale de Recherche sur le SIDA et les Hépatites virales CO12 CirVir cohort was to assess the occurrence of all clinical events in patients with compensated viral cirrhosis, including all types of cancer. Patients with the following inclusion criteria were enrolled in 35 French centers: (1) biopsy-proven hepatitis B virus (HBV) or hepatitis C virus (HCV) cirrhosis, (2) Child-Pugh A, or (3) absence of previous liver complications including primary liver cancer (PLC). Patients were followed up prospectively every 6 months. The standardized mortality ratio (SMR) was calculated according to age and gender using 5-year periods. The impact of sustained viral response (SVR) in HCV patients and maintained viral suppression in HBV patients were assessed using time-dependent analysis. A total of 1,671 patients were enrolled between 2006 and 2012 (median age, 54.9 years; men, 67.3%; HCV, 1,323; HBV, 317; HCV-HBV, 31). Metabolic features and excessive alcohol and tobacco consumption were recorded in 15.2%, 36.4%, and 56.4% of cases, respectively. After a median follow-up of 59.7 months, 227 PLCs were diagnosed (5-year cumulative incidence [CumI] 13.4%) and 93 patients developed EHC (14 patients with lymphoid or related tissue cancer and 79 with solid tissue cancer; 5-year EHC CumI, 5.9%). Compared to the general French population, patients were younger at cancer diagnosis, with significantly higher risk of EHC in HCV patients (SMR, 1.31; 95 confidence interval [CI], 1.04-1.64; P = 0.017) and after SVR (SMR = 1.57; 95% CI, 1.08-2.22; P = 0.013). EHC was the fourth leading cause of death in the whole cohort and the first in patients with viral control/eradication.

CONCLUSION:

Compared to the general French population, HCV cirrhosis is associated with a higher risk of EHC and the first cause of death in patients with viral cirrhosis who achieve virological control/eradication. (Hepatology 2018).

PMID:
29663511
DOI:
10.1002/hep.30034
[Indexed for MEDLINE]

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