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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/06  
 
  2018 Jun;67(6):2338-2351.  
  doi: 10.1002/hep.29730.  
 
  Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis.  
 
  Ali AH, Tabibian JH, Nasser-Ghodsi N, Lennon RJ, DeLeon T, Borad MJ, Hilscher M, Silveira MG, Carey EJ, Lindor KD  
  https://www.ncbi.nlm.nih.gov/pubmed/29244227  
 
 

Abstract

Primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa). Surveillance for GBCa is recommended, but the clinical utility of surveillance for other hepatobiliary cancers (HBCa) in PSC, namely CCA and hepatocellular carcinoma (HCC), remains unclear. We aimed to determine whether surveillance is associated with better survival after diagnosis of HBCa in patients with PSC. Medical records of PSC patients seen at the Mayo Clinic Rochester from 1995 to 2015 were reviewed. Patients were included if they had ≥1 year of follow-up and developed HBCa. Patients were categorized according to their surveillance status (abdominal imaging, carbohydrate antigen 19-9, and alpha-fetoprotein). The primary endpoints were HBCa recurrence, HBCa-related death, and all-cause mortality. Overall survival was assessed by the Kaplan-Meier survival method; HBCa-related survival was assessed using competing risk regression. Tests of significance were two-tailed, and a P value <0.05 was considered statistically significant. From 1995 to 2015, a total of 79 of 830 PSC patients were diagnosed with HBCa. Cumulative follow-up was 712 and 283 person-years pre- and post-HBCa diagnosis, respectively. Seventy-eight percent of patients (54/79) developed CCA, 21% (17/79) HCC, 6% (5/79) GBCa, 3% (2/79) both CCA and HCC, and 1% (1/79) both HCC and GBCa. Fifty-one percent (40/79) were under HBCa surveillance, and 49% (39/79) were not. Patients in the surveillance group had significantly higher 5-year overall survival (68% versus 20%, respectively; P < 0.001) and significantly lower 5-year probability of experiencing an HBCa-related adverse event (32% versus 75%, respectively; P < 0.001) compared with the no-surveillance group.

CONCLUSION:

This study demonstrates that HBCa surveillance significantly improves outcomes, including survival, in patients with PSC. (Hepatology 2018;67:2338-2351).

 

 
Question posée
 
La surveillance des patients avec cholangite sclérosante primitive (CSP) est-elle associée à une meilleure survie après un diagnostic de cancer hépato-biliaire (cholangiocarcinome, cancer de la vésicule, carcinome hépato-cellulaire (CHC)) ?
 
Question posée
 
Dans cette cohorte de la Mayo Clinic, 79/830 CSP (1995 à 2015) ont eu un cancer hépato-biliaire (68% cholangiocarcinome + 3% avec CHC, 21% CHC, 6% cancer de la vésicule). Les patients surveillés ont eu une survie à 5 ans supérieure (68% vs 20%) et une amélioration significative des autres facteurs pronostiques.
 
Commentaires

Pour la surveillance étaient effectués annuellement : échographie abdominale ou TDM ou IRM+/-biliIRM + CA19-9 et si cirrhose imagerie + AFP. Une validation de cette surveillance en dehors de la Mayo est plus que nécessaire.

 
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