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Non‐virological factors are drivers of hepatocellular carcinoma in virosuppressed hepatitis B cirrhosis: Results of ANRS CO 12 CirVir cohort
Author(s) -
Brichler Segolene,
Nahon Pierre,
Zoulim Fabien,
Layese Richard,
Bourcier Valerie,
Audureau Etienne,
Sutton Angela,
Letouze Eric,
Cagnot Carole,
Marcellin Patrick,
Guyader Dominique,
Roulot Dominique,
Pol Stanislas,
Ledinghen Victor,
Zarski JeanPierre,
Calès Paul,
Tran Albert,
Peron JeanMarie,
Mallat Ariane,
Riachi Ghassan,
Grange JeanDidier,
Blanc JeanFrederic,
Bacq Yannick,
Ouzan Denis,
Bronowicki JeanPierre,
Mathurin Philippe,
Larrey Dominique,
Alric Laurent,
Attali Pierre,
Serfaty Lawrence,
Pilette Christophe,
Bourlière Marc,
Thabut Dominique,
Silvain Christine,
Wartelle Claire,
Zucman David,
Christidis Christos,
RoudotThoraval Françoise,
GanneCarrie Nathalie
Publication year - 2019
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.13029
Subject(s) - medicine , hepatocellular carcinoma , hepatitis b virus , cirrhosis , cohort , gastroenterology , coinfection , hepatitis b , prospective cohort study , proportional hazards model , immunology , human immunodeficiency virus (hiv) , virus
Summary Worldwide, hepatocellular carcinoma ( HCC ) occurs mainly in Asian patients with hepatitis B virus ( HBV ) infection. This study aimed to decipher the environmental and virological factors associated with HCC occurrence and validate risk scoring systems in a French multicentre prospective cohort of HBV cirrhotic patients. Patients with biopsy‐proven Child‐Pugh A viral cirrhosis included in the ANRS CO 12 CirVir cohort who were HB sAg(+) without hepatitis C coinfection were selected for: (a) interview through a standardized questionnaire reporting coffee consumption and HCC familial history; (b) HB sAg quantification using baseline and sequential 2‐year frozen sera; (c) baseline HBV genotype determination; and (d) assessment of risk factors and applicability of HCC risk scores (Kaplan‐Meier analysis, Cox models). Among 317 patients studied (261 men, median age 53 years, past or ongoing antiviral treatment 93.3% and baseline detectable HBV DNA in 88 patients), the baseline and 2‐year median HB sAg levels were 810 and 463 IU / mL , respectively. After a median follow‐up of 65.2 months, 27 HCC cases were diagnosed (annual incidence: 1.6%). Three factors were independently associated with HCC occurrence: age > 50 years, platelets ≤ 150 × 10 3 /mm 3 and body mass index ≥ 30 kg/m 2 . Two out of five risk scores were validated, and the most accurate was PAGE ‐B at 1 year. Moreover, HCC in patients without maintained virological suppression seems more aggressive and less accessible to curative treatment. In conclusion, in French patients with HBV cirrhosis mostly virally suppressed, independent HCC risk factors were host‐related (age, obesity) or linked to the severity of cirrhosis (thrombopenia), and the European PAGE ‐B score was the most accurate risk score.