Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  2018 Dec;69(6):1274-1283.  
  doi: 10.1016/j.jhep.2018.07.022.  
  Estimate of hepatocellular carcinoma incidence in patients with alcoholic cirrhosis  
  Ganne-Carrié N, Chaffaut C, Bourcier V, Archambeaud I, Perarnau JM, Oberti F, Roulot D, Moreno C, Louvet A, Dao T, Moirand R, Goria O, Nguyen-Khac E, Carbonell N, Antonini T, Pol S, de Ledinghen V, Ozenne V, Henrion J, Péron JM, Tran A, Perlemuter G, Amiot X, Zarski JP, Beaugrand M, Chevret S; for CIRRAL Group.  



More than 90% of cases of hepatocellular carcinoma (HCC) occur in patients with cirrhosis, of which alcohol is a major cause. The CIRRAL cohort aimed to assess the burden of complications in patients with alcoholic cirrhosis, particularly the occurrence of HCC.


Patients with biopsy-proven compensated alcoholic cirrhosis were included then prospectively followed. The main endpoint was the incidence of HCC. Secondary outcomes were incidence of hepatic focal lesions, overall survival (OS), liver-related mortality and event-free survival (EFS).


From October 2010 to April 2016, 652 patients were included in 22 French and Belgian centers. During follow-up (median 29 months), HCC was diagnosed in 43 patients. With the limitation derived from the uncertainty of consecutive patients' inclusion and from a sizable proportion of dropouts (153/652), the incidence of HCC was 2.9 per 100 patient-years, and one- and two-year cumulative incidences of 1.8% and 5.2%, respectively. Although HCC fulfilled the Milan criteria in 33 cases (77%), only 24 patients (56%) underwent curative treatment. An explorative prognostic analysis showed that age, male gender, baseline alpha-fetoprotein, bilirubin and prothrombin were significantly associated with the risk of HCC occurrence. Among 73 deaths, 61 had a recorded cause and 27 were directly attributable to liver disease. At two years, OS, EFS and cumulative incidences of liver-related deaths were 93% (95% CI 90.5-95.4), 80.3% (95% CI 76.9-83.9), and 3.2% (95% CI 1.6-4.8) respectively.


This large prospective cohort incompletely representative of the whole population with alcoholic cirrhosis showed: a) an annual incidence of HCC of up to 2.9 per 100 patient-years, suggesting that surveillance might be cost effective in these patients; b) a high proportion of HCC detected within the Milan criteria, but only one-half of detected HCC cases were referred for curative treatments; c) a two-year mortality rate of up to 7%.


Cirrhosis is a risk factor for primary liver cancer, leading to recommendations for periodic screening. However, for alcohol-related liver disease the rational of periodic screening for hepatocellular carcinoma (HCC) is controversial, as registry and databased studies have suggested a low incidence of HCC in these patients and highly competitive mortality rates. In this study, a large cohort of patients with biopsy-proven alcoholic cirrhosis prospectively screened for HCC demonstrated a high annual incidence of HCC (2.9%) and a high percentage of small cancers theoretically eligible for curative treatment. This suggests that patients with liver disease related to alcohol should not be ruled out of screening.


Question posée
Estimation de l'incidence du carcinome hépatocellulaire chez les patients atteints de cirrhose alcoolique.
Question posée
Cette large cohorte prospective incomplètement représentative de l'ensemble de la population atteinte de cirrhose alcoolique a montré: a) une incidence annuelle du CHC allant jusqu'à 2,9 pour 100 années-patients, ce qui suggère que la surveillance pourrait être rentable chez ces patients; b) une forte proportion de CHC détectés selon les critères de Milan, mais seulement la moitié des cas de CHC détectés ont été adressés pour des traitements curatifs; c) un taux de mortalité sur deux ans pouvant atteindre 7%.

Très beau travail français sur le sujet, très informatif.