Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication
Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication
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DOI：
10.1002/hep.30034
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发表时间：
2018-10-01
期刊：
影响因子：
13.5
通讯作者：
Roudot-Thoraval, Francoise
中科院分区：
文献类型：
--
作者：
Allaire, Manon;Nahon, Pierre;Roudot-Thoraval, Francoise
关于代偿期病毒性肝硬化的肝外癌（EHC）的数据有限。前瞻性多中心Agence Nationale de Recherche sur le SIDA et les Hepatites virales CO 12 CirVir队列的目的是评估代偿期病毒性肝硬化患者（包括所有类型的癌症）的所有临床事件的发生率。符合以下入选标准的患者在35家法国中心入组：（1）活检证实的B型肝炎病毒（HBV）或丙型肝炎病毒（HCV）肝硬化，（2）Child-Pugh A级，或（3）既往无肝脏并发症，包括原发性肝癌（PLC）。每6个月对患者进行前瞻性随访。标准化死亡率（SMR）根据年龄和性别使用5年期计算。使用时间依赖性分析评估持续病毒应答（SVR）对HCV患者的影响和持续病毒抑制对HBV患者的影响。2006年至2012年期间，共招募了1，671例患者（中位年龄为54.9岁;男性，67.3%; HCV，1，323例; HBV，317例; HCV-HBV，31例）。在15.2%、36.4%和56.4%的病例中分别记录了代谢特征和过度饮酒和吸烟。中位随访59.7个月后，诊断出227例PLC（5年累积发病率[CumI] 13.4%），93例患者发生EHC（14例淋巴或相关组织癌患者和79例实体组织癌患者; 5年EHC CumI，5.9%）。与一般法国人群相比，患者在癌症诊断时更年轻，HCV患者（SMR，1.31; 95置信区间[CI]，1.04-1.64; P = 0.017）和SVR后（SMR = 1.57; 95%CI，1.08-2.22; P = 0.013）的EHC风险显著更高。EHC是整个队列中的第四大死亡原因，是病毒控制/根除患者的第一大死亡原因。结论：与一般法国人群相比，HCV肝硬化与EHC的风险较高相关，并且是实现病毒学控制/根除的病毒性肝硬化患者的首要死亡原因。（Hepatology 2018）。
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 Hepatites 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).