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Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/04  
 
  2016 Apr;63(4):1205-12  
  doi: 10.1002/hep.28267  
 
  Novel population-based study finding higher than reported hepatocellular carcinoma incidence suggests an updated approach is needed.  
 
  Hong TP, Gow P, Fink M, Dev A, Roberts S, Nicoll A, Lubel J, Kronborg I, Arachchi N, Ryan M, Kemp W, Knight V, Farrugia H, Thursfield V, Desmond P, Thompson AJ, Bell S  
  http://www.ncbi.nlm.nih.gov/pubmed/26435297  
 
 

Hepatocellular carcinoma (HCC) incidence is rising rapidly in many developed countries. Primary epidemiological data have invariably been derived from cancer registries that are heterogeneous in data quality and registration methodology; many registries have not adopted current clinical diagnostic criteria for HCC and still rely on histology for classification. We performed the first population-based study in Australia using current diagnostic criteria, hypothesizing that HCC incidence may be higher than reported. Incident cases of HCC (defined by American Association for the Study of Liver Diseases diagnostic criteria or histology) were prospectively identified over a 12-month period (2012-2013) from the population of Melbourne, Australia. Cases were captured from multiple sources: admissions to any of Melbourne's seven tertiary hospitals; attendances at outpatients; and radiology, pathology, and pharmacy services. Our cohort was compared to the Victorian Cancer Registry (VCR) cohort (mandatory notified cases) for the same population and period, and incidence rates were compared for both cohorts. There were 272 incident cases (79% male; median age: 65 years) identified. Cirrhosis was present in 83% of patients, with hepatitis C virus infection (41%), alcohol (39%), and hepatitis B virus infection (22%) the commonest etiologies present. Age-standardized HCC incidence (per 100,000, Australian Standard Population) was 10.3 (95% confidence interval [CI]: 9.0-11.7) for males and 2.3 (95% CI: 1.8 to 3.0) for females. The VCR reported significantly lower rates of HCC: 5.3 (95% CI: 4.4 to 6.4) and 1.0 (95% CI: 0.7 to 1.5) per 100,000 males and females respectively (P < 0.0001).

CONCLUSIONS:

HCC incidence in Melbourne is 2-fold higher than reported by cancer registry data owing to under-reporting of clinical diagnoses. Adoption of current diagnostic criteria and additional capture sources will improve registry completeness. Chronic viral hepatitis and alcohol remain leading causes of cirrhosis and HCC. (Hepatology 2016;63:1205-1212).

 
Question posée
 
Quelle est l’incidence du carcinome hépatocellulaire (CHC) en Australie à partir d’une étude de population et non d’un registre ?
 
Question posée
 
L’incidence du CHC à Melbourne par cette autre approche est 2 fois plus élevée que celle mise en évidence par le registre. Dans plus de 80%, les CHC compliquent une cirrhose surtout d’origine virale (VHC :41% ;VHB :22%) ou liée à l’alcool (39%).
 
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