Thématique :
- Foie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  2015 Nov;63(5):1212-9  
  doi: 10.1016/j.jhep.2015.06.008  
  Applicability and prognostic value of histologic scoring systems in primary sclerosing cholangitis  
  de Vries EM, Verheij J, Hubscher SG, Leeflang MM, Boonstra K, Beuers U, Ponsioen CY  


Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. At present, there is no appropriate histologic scoring system available for PSC, evaluating both degree of necroinflammatory activity (grade) and fibrosis (stage). The aim of this study was to assess if three scoring systems, commonly used in different liver diseases could be applied for grading and/or staging of PSC.


Sixty-four PSC patients from a Dutch cohort, who underwent diagnostic liver biopsy, were included. Staging was scored using Ishak, Nakanuma, and Ludwig systems. Grading was scored using Ishak and Nakanuma systems. Three measures of outcome were defined; transplant-free survival, time to liver transplantation (LTx) and occurrence of cirrhosis related symptoms (CRS). Association of grade and stage with outcome was estimated using Kaplan-Meier log-rank test, and Cox regression analysis. Correlation with biochemistry was assessed by Spearman's rank test.


There were strong associations between disease stage measured by Ishak, Nakanuma, and Ludwig staging systems with both outcome measuring transplant-free survival (Hazard ratio (HR) 2.56; 95% CI 1.11-5.89, HR 6.53; 95% CI 2.01-21.22, HR 1.94; 95% CI 1.00-3.79, respectively), and time to LTx (HR 4.18; 95%CI 1.51-11.56, HR 7.05; 95% CI 1.77-28.11, HR 3.13; 95%CI 1.42-6.87, respectively). Ishak and Nakanuma grading systems were not associated with CRS. Weak correlations between histopathology and liver biochemistry were shown.


Applying the Nakanuma, Ishak, and Ludwig histopathological staging systems is feasible and clinically relevant given their association with transplant-free survival and time to LTx. This suggests that these staging systems could be likely candidates for surrogate endpoints and stratification purposes in clinical trials in PSC.

Question posée
Travail à l’interface entre les cliniciens et les anatomo-pathologistes concernant la cholangite sclérosante primitive (CSP).
Question posée
Voir commentaire.

Ce travail à l’interface entre les cliniciens et les anatomo-pathologistes concernant la CSP prendra toute sa place lors des discussions collégiales bien utiles dans les services spécialisés qui organisent ces rencontres entre les médecins de terrain et ceux qui, derrière leur microscope et leurs outils biologiques, partagent la même passion pour l’hépatologie et la prise en charge de la CSP.