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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/03  
 
  2016 Mar;63(3):721-30  
  doi: 10.1002/hep.28387  
 
  Hepatitis C viral infection increases the risk of lymphoid-neoplasms: A population-based cohort study.  
 
  Su TH, Liu CJ, Tseng TC, Chou SW, Liu CH, Yang HC, Wu SJ, Chen PJ, Chen DS, Chen CL, Kao JH  
  http://www.ncbi.nlm.nih.gov/pubmed/26662347  
 
 

Chronic hepatitis C viral (HCV) infection has been associated with non-Hodgkin's lymphoma (NHL); however, the results are inconsistent among regions with different HCV prevalence rates. The temporal relationship, risk estimates, and association between HCV and lymphoid-neoplasms remain unclear. This study investigated the temporal relationship between HCV infection and lymphoid-neoplasms using a nationwide population-based cohort. Patients with chronic HCV infection were retrieved from the Taiwan National Health Insurance Research Database during 2001-2005 and designated as the HCV cohort. Those with prior malignancies or coinfected with hepatitis B or human immunodeficiency virus were excluded. The age, sex, and comorbidities, including rheumatological disorders and diabetes, were matched by propensity scores to another non-HCV cohort. Both cohorts were followed longitudinally until 2009 for a new diagnosis of any lymphoid-neoplasms or NHL. A total of 11,679 HCV and 46,716 non-HCV patients were included and followed for 8 years. The incidence rates of any lymphoid-neoplasms and NHL were significantly greater in the HCV cohort than the non-HCV cohort (48.4 versus 22.1, and 37.0 versus 17.5 per 100,000 person-years, respectively, both P < 0.001), even after we excluded lymphoid-neoplasms developed within the first year of follow-up. Cox proportional hazards regression analysis (after adjustment for age, sex, numbers of annual medical visits during follow-up, and comorbidities) indicated that HCV infection was associated with an increased risk of either any lymphoid-neoplasms (hazard ratio = 2.30, 95% confidence interval 1.55-3.43, P < 0.0001) or NHL (hazard ratio = 2.00, 95% confidence interval 1.27-3.16, P = 0.003).

CONCLUSION:

After adjustment for confounders and biases, chronic HCV infection is temporally associated with a two-fold increased risk of lymphoid-neoplasms, especially NHL, in Asian patients; additional large studies are needed to explore whether HCV eradication can reduce the incidence of lymphoid-neoplasms. (Hepatology 2016;63:721-730).

 
Question posée
 
L’infection VHC augmente-t-elle le risque de cancer lymphoïde ou lymphome non hodgkinien ?
 
Question posée
 
Etude d’une cohorte de patients de Taïwan mono-infectés VHC (n=11679) inclus de 2001 à 2005 et suivis jusqu’en 2009 comparés à une cohorte de patients non VHC appariés (n=46716). L’incidence de cancer lymphoïde et de lymphome non hodgkinien/100 000 personnes par an est respectivement de 48,4 vs 22,1 et de 37,0 à vs 17,5 soit un HR respectivement de 2,3 (1,55-3,43) et de 2 (1,27-3,16) avec une différence significative entre les VHC positifs vs négatifs.
 
Commentaires

En Asie, en l’absence d’éradication virale C, le risque de cancer lymphoïde et de lymphome non hodgkinien est 2 fois plus important chez les patients infectés par le VHC et suivis pendant presque 10 ans. Même s’il s’agit d’une cohorte asiatique, il faut penser à ces diagnostics chez les patients suivis en Europe et non éradiqués.

 
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