Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort
Por:
Gelu-Simeon M, Lewin M, Ostos M, Bayan T, Beso Delgado M, Teicher E, Layese R, Roudot-Thoraval F, Fontaine H, Sobesky R, Salmon-Céron D, Samuel D, Seror O, Nahon P, Meyer L, Duclos-Vallée JC and ANRS HC EP 25 Prethevic, A
Publicada:
1 ene 2019
Categoría:
Hepatology
Resumen:
Background & Aims HIV/HCV co-infected patients with hepatocellular carcinoma (HCC) have poorer survival than HCV mono-infected patients. We aimed to evaluate the prognostic factors for survival. Methods From 2006 to 2013, 55 incident HCCs among HIV+/HCV+ patients, from three ANRS cohorts, were compared with 181 HCCs in HIV-/HCV+ patients from the ANRS Cirvir cohort. Results HIV+/HCV+ patients were younger (50 years [IQR: 47-53] vs 62 [54-70], P < 0.001), male (89% vs 63%, P < 0.001) than HIV-/HCV+ patients. At HCC diagnosis, both groups had a majority of non-responders to anti-HCV-therapy, and HIV+/HCV+ patients had more frequently known a previous cirrhosis decompensation (31% vs 14%, P = 0.005). At diagnostic imaging, there were more infiltrative forms of HCC in HIV+/HCV+ group (24% vs 14%, P < 0.001), associated with tumour portal thrombosis in 29%. During a median follow-up period of 11.96 [5.51-27] months since HCC diagnosis, a majority of palliative treatments were decided in HIV+/HCV+ patients (51% vs 19%, P < 0.001). The 1 and 2-year crude survival rates were 61% versus 78% and 47% versus 63%, P = 0.003 respectively. In a Cox model multivariate analysis adjusted for the cohort, age and sex, the most important prognostic factor for survival was the infiltrative form of the tumour (aRR: 8.10 [4.17-15.75], P 0.001). Conclusions The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High alpha-foetoprotein level and decompensated cirrhosis are other ones. This justifies a particular attention to the detection and the management of small nodules in this high-risk population.
Filiaciones:
Gelu-Simeon M:
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
DHU Hepatinov, Villejuif, France
CHU de Guadeloupe, Service d'Hépato-Gastro-Entérologie, Faculté de Médecine Hyacinthe Bastaraud, Université Antilles-Guyane, Guadeloupe, France
Inserm-UMR-S1085/IRSET, Rennes, France
Lewin M:
DHU Hepatinov, Villejuif, France
Service de Radiologie, AP-HP Hôpital Paul-Brousse, Villejuif, France
Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Ostos M:
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
DHU Hepatinov, Villejuif, France
Bayan T:
Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
:
Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Teicher E:
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
DHU Hepatinov, Villejuif, France
Service de Médecine Interne, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
Layese R:
AP-HP Hôpital Henri Mondor, URC-CEpiA-EA7376, Université Paris Est, Créteil, France
Roudot-Thoraval F:
AP-HP Hôpital Henri Mondor, URC-CEpiA-EA7376, Université Paris Est, Créteil, France
Fontaine H:
Unité d'Hépatologie, AP-HP Hôpital Cochin, USM20, Institut Pasteur, Université Paris-Descartes, Paris, France
Sobesky R:
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
DHU Hepatinov, Villejuif, France
Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
Salmon-Céron D:
Service des Maladies Infectieuses et Tropicales, AP-HP Hôpital Cochin, Université Paris Descartes, Paris, France
Samuel D:
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
DHU Hepatinov, Villejuif, France
Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
Seror O:
Service de Radiologie, AP-HP Hôpital Jean Verdier, Université Paris13, Bondy, France
Nahon P:
Service d'Hépato-Gastro-Entérologie, AP-HP Hôpital Jean Verdier, Bondy, France
Bobigny, Inserm-UMR1162, Université Paris13, Paris, France
Meyer L:
Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Service de Santé Publique, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
Duclos-Vallée JC:
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
DHU Hepatinov, Villejuif, France
Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
CHU Purpan, Hepatogastroenterol, Toulouse, France.
CHU Archet, Infectiol, Nice, France.
CHU Bicetre, Med Interne, Le Kremlin Bicetre, France.
CH Perpignan, Malad Infect & Trop, Perpignan, France.
CHU Strasbourg, CISIH, Strasbourg, France.
Green Published
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