Volume 62, Issue 3, pages 737–750, September 2015
Article has an altmetric score of 5
Additional Information(Show All)
1 AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
2 AP-HP, Hôpital Saint-Louis, SBIM, Université Paris Diderot, Inserm UMR 1153, Paris, France
3 ANRS (Agence Nationale de Recherche sur le SIDA et les hépatites virales), Paris, France
4 AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
5 CHU Pontchaillou, Service d'Hépatologie, Rennes, France
6 AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM U1016, Université Paris Descartes, Paris, France
7 Hôpital Saint Eloi, Service d'Hépatologie, Montpellier, France
8 Hôpital Haut-lévêque, Service d'Hépatologie, Bordeaux, France
9 Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
10 Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France
11 AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France
12 CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
13 Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy, France
14 Hôpital Michallon, Service d'Hépatologie, Grenoble, France
15 Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
16 CHU d'Angers, Service d'Hépatologie, Angers, France
17 Hôpital Purpan, Service d'Hépatologie, Toulouse, France
18 CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
19 Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
20 Hôpital Claude Huriez, Service d'Hépatologie, Lille, France
21 Hôpital St André, Service d'Hépatologie, Bordeaux, France
22 Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
23 AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
24 AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
25 AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris, France
26 AP-HP, CHU Kremlin-Bicêtre, Service d'Hépatologie, Le Kremlin-Bicêtre, France
27 Hôpital Trousseau, Service d'Hépatologie, Tours, France
28 Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
29 Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
30 AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
31 CHU Le Mans, Service d'Hépatologie, Le Mans, France
32 CHU de Poitiers, Service d'Hépatologie, Poitiers, France
33 Institut Mutualiste Montsouris, Service d'Hépatologie, Paris, France
34 Hôpital Amiens Nord, Service d'Hépatologie, Amiens, France
35 Hôpital Robert Debré, Service d'Hépatologie, Reims, France
36 Hôpital Foch, Service d'Hépatologie, Suresnes, France
37 Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France
† Coauthors.
*Address reprint requests to: Pierre Nahon, M.D., Ph.D., Service d'Hépato-gastroentérologie, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France. E-mail: [email protected]; fax: 33-1-48-02-62-02.
Potential conflict of interest: Dr. Zarski consults and is on the speakers' bureau for Gilead, Bristol-Myers Squibb, Janssen, Siemens, and MSD. He consults for AbbVie. Dr. Pol consults for and received grants from Bristol-Myers Squibb, Gilead, Roche, and MSD. He consults for Boehringer Ingelheim, Vertex, Janssen, AbbVie, Sanofi, and GlaxoSmithKline. Dr. Alric consults and received grants from Bristol-Myers Squibb, MSD, and Gilead. He received grants from Roche and Janssen. Dr. Trinchet consults for Bayer, Bristol-Myers Squibb, and Janssen. Dr. Bourliere consults and advises AbbVie, MSD, Janssen, Bristol-Myers Squibb, Roche, and Gilead. Dr. Di Martino consults and advises Gilead and MSD. He advises Janssen and Bristol-Myers Squibb.
This study was sponsored and funded by the ANRS (Agence Nationale de Recherche sur le SIDA et les Hépatites virales).
This article is dedicated to the memory of Jean-Claude Trinchet, founder of the CirVir cohort, for his outstanding contribution in liver cancer research during his career.
Various critical events, liver related or not, occur in patients with compensated cirrhosis, but their respective burden remains to be prospectively assessed. The aim of this prospective cohort study involving 35 French centers was to capture the whole spectrum of complications occurring in compensated viral cirrhosis (VC) using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis resulting from hepatitis C virus (HCV) or hepatitis B virus (HBV); Child-Pugh A; and no previous hepatic complications. The cohort was considered as a multistate disease model, cumulative incidences (CumIs) of events were estimated in a competing risks framework. A total of 1,654 patients were enrolled from 2006 to 2012 (HCV, 1,308; HBV, 315; HCV-HBV, 31). During a median follow-up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4-year cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4-year cumI: 11.4% vs. 7.4%; P = 0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4-year cumI: 10.8% vs. 3.6%; P = 0.0004). Virological eradication/control was achieved in 34.1% of HCV and 88.6% of HBV patients and was associated with a marked decrease in HCC, decompensation, and bacterial infection incidences. Survival was shorter in HCV patients (4-year cumI: 91.6% vs. 97.2%; P = 0.0002). Death (n = 102; missing data: 6) was attributed to liver disease in 48 (47%; liver cancer: n = 18; miscellaneous, n = 30) and extrahepatic causes in 48 (47%; bacterial infection: n = 13; extrahepatic cancers: n = 10; cardiovascular events: n = 5; miscellaneous, n = 20). Conclusion: After 3 years of follow-up, extrahepatic events still explained half of deaths in patients with compensated VC. A strong decrease in complications was linked to virological eradication/control. (Hepatology 2015;62:737–750) 作者: StephenW 时间: 2015-8-26 08:40