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Abstract Details |
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Nomogram for individualized prediction of hepatocellular carcinoma occurrence in HCV-cirrhosis (ANRS CO12 CirVir) |
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Ganne-Carrié N1,2,3, Layese R4, Bourcier V1, Cagnot C5, Marcellin P6, Guyader D7, Pol S8, Larrey D9, de Lédinghen V10, Ouzan D11, Zoulim F12, Roulot D2,13, Tran A14, Bronowicki JP15, Zarski JP16, Riachi G17, Calès P18, Péron JM19, Alric L20, Bourlière M21, Mathurin P22, Blanc JF23, Abergel A24, Serfaty L25, Mallat A26, Grangé JD27, Attali P28, Bacq Y29, Wartelle C30, Dao T31, Benhamou Y32, Pilette C33, Silvain C34, Christidis C35, Capron D36, Bernard-Chabert B37, Zucman D38, Di Martino V39, Trinchet JC1,2,3, Nahon P1,2,3, Roudot-Thoraval F4; ANRS CO12 CirVir study group. Hepatology. 2016 Jun 27. doi: 10.1002/hep.28702. [Epub ahead of print] |
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Collaborators (38)
Author information
1AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy.
2Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206, Saint-Denis.
3Inserm, UMR-1162 "Génomique fonctionnelle des tumeurs solides", F-75010, Paris.
4Département de Santé Publique, AP-HP, Hôpital Henri Mondor, Créteil.
5Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & Sud Sida-HIV Hépatites-FRENSH).
6AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy et université Paris 7.
7CHU Pontchaillou, Service d'Hépatologie, Rennes.
8Université Paris Descartes; APHP, Unité d'Hépatologie, Hôpital Cochin; INSERM U-818 et USM20, Institut Pasteur, Paris.
9Hôpital Saint Eloi, Service d'Hépatologie, Montpellier.
10Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux.
11Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var.
12Hospices Civils de Lyon Service, d'Hépatologie, Université de Lyonet, INSERM U1052, Lyon.
13AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny.
14CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice.
15Inserm 954, CHU de Nancy, Université de Lorraine, Vandoeuvre-les-Nancy.
16clinique d'hépato-gastroentérologie pôle Digidune Chu de Grenoble.
17Hôpital Charles- Nicolle, Service d'Hépatologie, Rouen.
18CHU d'Angers, Service d'Hépato-Gastroentérologie, et Université Bretagne-Loire.
19Hôpital Purpan, Service d'Hépatologie, et université Paul Sabatier III, Toulouse.
20CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse.
21Hôpital Saint Joseph, Service d'Hépatologie, Marseille.
22Hôpital Claude Huriez, Service d'Hépatologie, Lille.
23Hôpital St André, Service d'Hépatologie, Bordeaux.
24Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand.
25AP-HP, Hôpital Saint- Antoine, Service d'Hépatologie, Paris.
26AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil.
27AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris.
28AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif.
29Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours.
30Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence.
31Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen.
32AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris.
33CH Le Mans, Service d'Hépatologie, Le Mans.
34CHU de Poitiers, Service d'Hépatologie, Poitiers.
35Institut Mutualiste Montsouris, Service d'Hépatologie, Paris.
36Hôpital Amiens Nord, Service d'Hépatologie, Amiens.
37Hôpital Robert Debré, Service d'Hépatologie, Reims.
38Hôpital Foch, Service de Médecine Interne, Suresnes.
39Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, FRANCE.
Abstract
BACKGROUND:
To develop an individualized score for predicting hepatocellular carcinoma (HCC) in patients with hepatitis C (HCV)-compensated cirrhosis.
METHODS:
Among 1,323 patients with HCV-cirrhosis enrolled in the French prospective ANRS CO12 CirVir cohort, 720 and 360 were randomly assigned to training and validation sets, respectively. Cox multivariate model was used to predict HCC, after which a nomogram was computed to assess individualized risk.
RESULTS:
During follow-up (median: 51.0 months), 103 and 39 patients developed HCC in the training and validation sets, respectively. Five variables were independently associated with occurrence of HCC: age > 50 years (HR 1.94, 95%CI [1.16; 3.25], p=0.012); past excessive alcohol intake (HR 1.55, 95%CI [1.02; 2.36], p=0.041); low platelet count (< 100 Giga/mm3: HR 2.70, 95% CI [1.62; 4.51], p < 0.001; [100; 150] Giga/mm3: HR 1.87, 95%CI [1.10; 3.18], p=0.021); GGT above the upper limit of normal (HR 1.96, 95%CI [1.11; 3.47], p=0.021); and absence of a sustained virological response during follow-up (HR 3.02, 95%CI [1.67; 5.48], p<0.001). An 11-point risk score was derived from the training cohort and validated in the validation set. Based on this score, the population was stratified into three groups, in which HCC development gradually increased, from 0% to 30.1% % at 5 years for patients with the lowest (≤ 3) and highest (≥ 8) scores (p < 0.001). Using this score, a nomogram was built enabling individualized prediction of HCC occurrence at 1, 3 and 5 years.
CONCLUSIONS:
This HCC score can accurately predict HCC at an individual level in French patients with HCV-cirrhosis.
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