SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
- Hépatites virales
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gut
  2015/08  
 
  2015 Aug;64(8):1289-95  
  doi:10.1136/gutjnl-2014-307023  
 
  Entecavir treatment does not eliminate the risk of hepatocellular carcinoma in chronic hepatitis B: limited role for risk scores in Caucasians  
 
  Arends P, Sonneveld MJ, Zoutendijk R, Carey I, Brown A, Fasano M, Mutimer D, Deterding K, Reijnders JG, Oo Y, Petersen J, van Bömmel F, de Knegt RJ, Santantonio T, Berg T, Welzel TM, Wedemeyer H, Buti M, Pradat P, Zoulim F, Hansen B, Janssen HL; VIRGIL Surveillance Study Group  
  http://www.ncbi.nlm.nih.gov/pubmed/25011935  
 
 

Background
Hepatocellular carcinoma (HCC) risk-scores may predict HCC in Asian entecavir (ETV)-treated patients. We aimed to study risk factors and performance of risk scores during ETV treatment in an ethnically diverse Western population.

Methods
We studied all HBV monoinfected patients treated with ETV from 11 European referral centres within the VIRGIL Network.

Results
A total of 744 patients were included; 42% Caucasian, 29% Asian, 19% other, 10% unknown. At baseline, 164 patients (22%) had cirrhosis. During a median follow-up of 167 (IQR 82–212) weeks, 14 patients developed HCC of whom nine (64%) had cirrhosis at baseline. The 5-year cumulative incidence rate of HCC was 2.1% for non-cirrhotic and 10.9% for cirrhotic patients (p<0.001). HCC incidence was higher in older patients (p<0.001) and patients with lower baseline platelet counts (p=0.02). Twelve patients who developed HCC achieved virologic response (HBV DNA <80 IU/mL) before HCC. At baseline, higher CU-HCC and GAG-HCC, but not REACH-B scores were associated with development of HCC. Discriminatory performance of HCC risk scores was low, with sensitivity ranging from 18% to 73%, and c-statistics from 0.71 to 0.85. Performance was further reduced in Caucasians with c-statistics from 0.54 to 0.74. Predicted risk of HCC based on risk-scores declined during ETV therapy (all p<0.001), but predictive performances after 1 year were comparable to those at baseline.

Conclusions
Cumulative incidence of HCC is low in patients treated with ETV, but ETV does not eliminate the risk of HCC. Discriminatory performance of HCC risk scores was limited, particularly in Caucasians, at baseline and during therapy.

 
Question posée
 
Le traitement par Entecavir chez des patients caucasiens réduit-il le risque de carcinome hépatocellulaire et les scores développés chez les patents asiatiques peuvent –ils être appliqués pour prédire ce risque ?
 
Question posée
 
Le risque de carcinome hépatocellulaire persiste malgré la viro-suppression et quelle qu’en soit sa durée justifiant de continuer la surveillance à la recherche de carcinome hépatocellulaire chez les patients traités par Entecavir. Les différents scores (GAG HCC, CU HCC, REACH-B HCC) ne sont pas utiles.
 
Commentaires

Chez les patients traités par entécavir surtout en cas de cirrhose, la surveillance à la recherche d’un carcinome hépatocellulaire est toujours nécessaire. L’histoire naturelle des patients VHB traités par Entécavir est parfaitement bien décrite et peut servir de référence pour les patients non asiatiques.

 
www.snfge.org