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Thématique :
- Carcinome hépatocellulaire (CHC)
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2017/11  
 
  November 2017 Volume 67, Issue 5, Pages 933–939  
  DOI: http://dx.doi.org/10.1016/j.jhep.2017.05.028  
 
  http://dx.doi.org/10.1016/j.jhep.2017.05.028  
 
  Hiroko Nagata, Mina Nakagawa, Yasuhiro Asahina'Correspondence information about the author Yasuhiro AsahinaEmail the author Yasuhiro Asahina, Ayako Sato, Yu Asano, Tomoyuki Tsunoda, Masato Miyoshi, Shun Kaneko, Satoshi Otani, Fukiko Kawai-Kitahata, Miyako Murakawa, Sayuri Nitta, Yasuhiro Itsui, Seishin Azuma, Sei Kakinuma, Toshihiko Nouchi, Hideki Sakai, Makoto Tomita, Mamoru Watanabe and the Ochanomizu Liver Conference Study Group  
  http://www.journal-of-hepatology.eu/article/S0168-8278(17)32070-6/abstract  
 
 

Background and Aims

Although treatment for hepatitis C virus has been dramatically improved by the development of direct-acting antiviral agents (DAAs), whether interferon (IFN)-free therapy reduces hepatocarcinogenesis in an equivalent manner to IFN-based therapy remains controversial. The aims of this study were to evaluate the occurrence and recurrence of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients treated with DAAs and to identify biomarkers of HCC development after antiviral treatment.

Methods

A restrospective review of a prospective database of 1,897 CHC patients who were treated with IFN-based (1,145) or IFN-free therapies (752) was carried out. Cumulative HCC occurrence and recurrence rates were compared using propensity score-matched analysis. Predictors of HCC development after viral eradication were identified by multivariate analysis.

Results

Propensity score-matched analysis showed no significant difference in HCC occurrence (p = 0.49) and recurrence rates (p = 0.54) between groups treated with IFN-based or IFN-free therapies. In multivariate analysis, higher levels of post-treatment α-fetoprotein (AFP) or Wisteria floribunda agglutinin positive Mac-2 binding protein (WFA+M2BP) were independently associated with HCC occurrence and recurrence after viral eradication. Only post-treatment WFA+M2BP level was significantly associated with HCC occurrence and recurrence among patients without severe fibrosis. The area under the receiver operating characteristic (ROC) curve for WFA+M2BP levels was greater than that for AFP levels in ROC analysis.

Conclusion

The risks of early HCC occurrence and recurrence after viral eradication were similar between IFN-based and IFN-free therapies. Post-treatment levels of WFA+M2BP may be helpful screening biomarkers for assessing the risk of HCC after IFN-free therapy. Patients with high WFA+M2BP levels after antiviral treatment, even without severe fibrosis, must be followed up carefully for HCC development.

Lay summary: The risks of early HCC occurrence and recurrence after viral eradication were similar between IFN-based and IFN-free therapies. Post-treatment levels of WFA+M2BP may be helpful screening biomarkers for assessing the risk of HCC after IFN-free therapy.

 
Question posée
 
Effet de l'interféron (IFN) et des nouvelles thérapies sans interféron sur l'apparition précoce et la récidive du carcinome hépatocellulaire (CHC) dans l'hépatite C chronique.
 
Question posée
 
Les risques de survenue précoce d'un CHC et la récurrence après l'éradication virale étaient similaires chez les patients traités par IFN ou les thérapies sans IFN. Un nouveau marqueur le WFA + M2BP après traitement pourrait être utile pour évaluer le risque de CHC après un traitement sans IFN, les patients ayant des taux élevés de WFA + M2BP après un traitement antiviral, même sans fibrose sévère, devraient faire l'objet d'un suivi particulier pour évaluer la survenue d’un CHC.
 
Commentaires

Un travail supplémentaire qui vient nous rassurer concernant l’incidence du CHC après traitements éradicateurs du VHC. Par ailleurs, ce nouveau marqueur le WFA + M2BP, justifie une attention particulière.

 
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