Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort.
Aged
Antiviral Agents
/ therapeutic use
Carcinoma, Hepatocellular
/ mortality
Coinfection
/ drug therapy
Female
France
HIV Infections
/ complications
Hepatitis C
/ complications
Humans
Liver Cirrhosis
/ complications
Liver Neoplasms
/ mortality
Male
Middle Aged
Prognosis
Prospective Studies
Risk Factors
Survival Rate
HIV/HCV co-infected patients
hepatocellular carcinoma
prognostic factors
therapeutic strategy
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
24
11
2017
accepted:
15
06
2018
pubmed:
28
6
2018
medline:
9
1
2020
entrez:
28
6
2018
Statut:
ppublish
Résumé
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. 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. 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). The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High α-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.
Sections du résumé
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 α-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.
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
136-146Investigateurs
Ventzislava Petrov-Sanchez
(V)
Brigitte Autran
(B)
Faroudy Boufassa
(F)
Marc Bourlière
(M)
Stéphanie Dominguez
(S)
Christophe Hézode
(C)
Georges-Philippe Pageaux
(GP)
Isabelle Poizot-Martin
(I)
Anne-Marie Roque-Afonso
(AM)
Assia Samri
(A)
Daniel Vittecoq
(D)
F Dabis
(F)
M Winnock
(M)
A Loko
(A)
P Sogni
(P)
Y Benhamou
(Y)
P Trimoulet
(P)
J Izopet
(J)
V Paradis
(V)
B Spire
(B)
P Carrieri
(P)
C Katlama
(C)
G Pialoux
(G)
A Valantin
(A)
P Bonnard
(P)
I Poizot-Martin
(I)
B Marchou
(B)
E Rosenthal
(E)
D Garipuy
(D)
O Bouchaud
(O)
A Gervais
(A)
C Lascoux-Combe
(C)
C Goujard
(C)
K Lacombe
(K)
C Duvivier
(C)
D Vittecoq
(D)
D Neau
(D)
P Morlat
(P)
F BaniSadr
(F)
F Boufassa
(F)
S Dominguez
(S)
B Autran
(B)
M Roque
(M)
C Solas
(C)
L Serfaty
(L)
G Chêne
(G)
D Costagliola
(D)
D Zucman
(D)
A Simon
(A)
S Dominguez
(S)
E Billaud
(E)
P Miailhes
(P)
J Devoto
(J)
S Couffin-Cadiergues
(S)
P Nahon
(P)
V Mahuas-Bourcier
(V)
J Zucman-Rossi
(J)
P Bedossa
(P)
A Laurent
(A)
R Layese
(R)
I Durand-Zaleski
(I)
P Marche
(P)
V Thibault
(V)
D Guyader
(D)
S Dharancy
(S)
V Leroy
(V)
V Vilgrain
(V)
M Bonjour
(M)
C Cagnot
(C)
V Petrov-Sanchez
(V)
Informations de copyright
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.