Thématique :
- Foie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  537-544. 2016 Oct 20.  
  DOI: 10.1016/j.jhep.2016.10.015  
  Geographical variations in incidence, management and survival of hepatocellular carcinoma in a Western country  
  Nathalie Goutté, Philippe Sogni, Noelle Bendersky, Jean Claude Barbare, Bruno Falissard, Olivier Farges  

BACKGROUND & AIMS: Information on the incidence, management, and prognosis of hepatocellular carcinoma (HCC) is derived from population samples, regional data, or registries. Comprehensive national evaluations within a given country are lacking. This study aimed to investigate regional variations in HCC care within France.

METHODS: This observational study analysed data from French administrative databases for more than 30,000 patients with HCC diagnosed between 2009 and 2012, and followed-up until 2013. The incidence of HCC, access to surgery, and survival, at both the national level and two geographical levels (the 21 French regions and 95 French departments into which France is divided administratively), were determined. The influence on outcome of the structure of the hospital where HCC was first managed was assessed.

RESULTS: At the national level, the median survival was 9.4months and only 22.8% of patients had curative treatment. There were marked variations between regions and departments in incidence, access to curative treatment (range 1.3-28.8% and 8.1-32.3% respectively), and in median survival (range 5.7-12.1 and 4.3-16.5months respectively). The administrative type and annual HCC-caseload of the hospital where patients were first admitted also had an independent influence on treatment and survival.

CONCLUSION: Despite full insurance coverage for all citizens, national measures to reduce inequities in the management of cancer patients, standardised recommendations for HCC surveillance and management, the percentage of patients undergoing curative treatment and their survival may vary four-fold depending on their postcode. The hospital in which patients are first managed has a clear influence on accessibility to both good care and survival.

LAY SUMMARY: Population-based studies have highlighted large and sometimes unexpected differences between countries in the survival of patients with malignancy. As these differences are considered to indicate the overall effectiveness of health systems, in addition to the incidence of the cancer or quality of registration, variations within a given country should be minimal. However, similar to between countries differences, this study shows differences within the same country in the incidence, curative treatment rate, and survival of patients with HCC. Evidence that access to care and survival varies within a country can strengthen the impetus for government and clinicians to address these disparities.


Question posée
Variations géographiques de l'incidence, de la gestion et de la survie du carcinome hépatocellulaire (CHC) dans un pays de l'Europe de l’Ouest (la France).
Question posée
En dépit d'une couverture d'assurance maladie identique pour tous les citoyens, des mesures nationales visant à réduire les inégalités dans la prise en charge des patients atteints de cancer, des recommandations normalisées pour la surveillance et la gestion du CHC, le pourcentage de patients recevant un traitement curatif et leur survie peuvent varier de 1 à 4 selon leur code postal. L'hôpital dans lequel les patients sont gérés pour la première fois a une influence nette sur l'accessibilité aux soins les plus efficaces et à la survie.