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Gastroenterology. 2018 Aug;155(2):431-442.e10. doi: 10.1053/j.gastro.2018.04.027. Epub 2018 May 3.

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

Author information

1
Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France. Electronic address: charlotte.costentin.pro@gmail.com.
2
Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France.
3
Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France.
4
Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord & sud Sida-HIV Hépatites, Paris, France.
5
Assistance Publique-Hopitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
6
Centre Hospitalier Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France.
7
Assistance Publique-Hopitaux de Paris, Hôpital Cochin, Département d'Hépatologie et Institut National de la Santé et de la Recherche Médicale, Institut Pasteur, Université Paris Descartes, Paris, France.
8
Hôpital Saint Eloi, Service d'Hépatologie, Montpellier, France.
9
Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux, France.
10
Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France.
11
Hospices Civils de Lyon, Département d'Hépatologie, Lyon, France.
12
Assistance Publique-Hopitaux de Paris, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France.
13
Centre Hospitalier Universitaire de Nice, Service d'Hépatologie, et Institut National de la Santé et de la Recherche Médicale, Université de Nice-Sophia-Antipolis, Nice, France.
14
Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy, France.
15
Hôpital Michallon, Service d'Hépatologie, Grenoble, France.
16
Hôpital Charles-Nicolle, Service d'Hépato-gastroentérologie, Rouen, France.
17
Centre Hospitalier Universitaire d'Angers, Service d'Hépatologie, Angers, France.
18
Hôpital Purpan, Service d'Hépatologie, Toulouse, France.
19
Centre Hospitalier Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif, Toulouse, France.
20
Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France.
21
Hôpital Claude Huriez, Service d'Hépatologie, Lille, France.
22
Hôpital St André, Service d'Hépatologie, Bordeaux, France.
23
Centre Hospitalier Universitaire Estaing, Service d'Hépatologie, Clermont-Ferrand, France.
24
Assistance Publique-Hopitaux de Paris, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France.
25
Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; L'Université Paris-Est Créteil et Institut National de la Santé et de la Recherche Médicale, Créteil, France.
26
Assistance Publique-Hopitaux de Paris, Hôpital Tenon, Service d'Hépatologie, Paris, France.
27
Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France.
28
Hôpital Trousseau, Unité d'Hépatologie, Centres Hospitaliers Régionaux et Universitaires de Tours, Tours, France.
29
Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France.
30
Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France.
31
Assistance Publique-Hopitaux de Paris, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France.
32
Centre Hospitalier Universitaire Le Mans, Service d'Hépatologie, Le Mans, France.
33
Centre Hospitalier Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France.
34
Institut Mutualiste Montsouris, Service d'Hépatologie, Paris, France.
35
Hôpital Amiens Sud, Service d'Hépatologie, Amiens, France.
36
Hôpital Robert Debré, Service d'Hépatologie, Reims, France.
37
Hôpital Foch, Service d'Hépatologie, Suresnes, France.
38
Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France.
39
Liver Disease Biobank, Groupe Hospitalier Paris Seine-Saint-Denis, France; Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Institut National de la Santé et de la Recherche Médicale U1148, Université Paris 13, Bobigny, France.
40
Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France.
41
Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France; Assistance Publique-Hopitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Oncologie, Paris, France.
42
Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France.
43
Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France.

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:

Curative Treatment; Early Detection; Liver Cancer; Screening

PMID:
29729258
DOI:
10.1053/j.gastro.2018.04.027
[Indexed for MEDLINE]

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