AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer(BCLC) stage C hepatocellular carcinoma(HCC) and to ascertain the factors predicting the achievement of disease control(DC).METH...AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer(BCLC) stage C hepatocellular carcinoma(HCC) and to ascertain the factors predicting the achievement of disease control(DC).METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo(95%CI: 10.6-17.0). Only alphafetoprotein(AFP) serum level > 200 ng/m L and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up(HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year(HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC(OR = 0.263, 95%CI: 0.111-0.622, P = 0.002).CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.展开更多
Hepatitis C virus(HCV)infection is a major cause of liver disease and hepatocellular carcinoma worldwide(1).HCV is a blood-borne infection and prevalence is particularly high in patients with a history of injective dr...Hepatitis C virus(HCV)infection is a major cause of liver disease and hepatocellular carcinoma worldwide(1).HCV is a blood-borne infection and prevalence is particularly high in patients with a history of injective drug use or unsafe health care or sexual practices.Substance use disorder(SUD),and especially opioid misuse is a growing problem worldwide(2).This is particularly relevant in the United States(US)where opioid misuse has raised sharply in the last years(3,4),termed also opioid epidemic.SUD is associated with an increase incidence of HCV infections and reinfections and associated liver disease(2,4).Moreover,alcohol use disorder is frequent in patients with SUD(5),representing another major risk factor for chronic liver disease in this population.Patients with SUD often experience poor access to health care resulting in higher mortality(5,6).Finally,SUD is associated with psychiatric conditions and social problems such as housing instability,unemployment,and reduced access to medical care(7)which could result in a reduced access and compliance to HCV treatment.展开更多
Liver cirrhosis and primary liver cancers are leading causes of mortality worldwide with over than 1.7 million of deaths in 2010 representing about 3.4%of the overall deaths(1).Global liver cirrhosis deaths ceaselessl...Liver cirrhosis and primary liver cancers are leading causes of mortality worldwide with over than 1.7 million of deaths in 2010 representing about 3.4%of the overall deaths(1).Global liver cirrhosis deaths ceaselessly increased by 52.2%from 1980 to 2010(1).Similarly,primary liver cancers global deaths increased by 62.4%from 1990 to 2010(2).展开更多
Hepatitis C virus(HCV)is a main cause and important risk factor for hepatocellular carcinoma(HCC)in Western countries(1).Direct antiviral agents(DAAs)for HCV are highly effective and well-tolerated antiviral drugs whi...Hepatitis C virus(HCV)is a main cause and important risk factor for hepatocellular carcinoma(HCC)in Western countries(1).Direct antiviral agents(DAAs)for HCV are highly effective and well-tolerated antiviral drugs which allow HCV cure even in patients with advanced liver disease.However,whilst HCV cure improves liver function and decreases overall HCC risk,a significant HCC risk persists in particular in patients with advanced fibrosis including cirrhosis who have the highest risk of developing HCC(2-4).展开更多
文摘AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer(BCLC) stage C hepatocellular carcinoma(HCC) and to ascertain the factors predicting the achievement of disease control(DC).METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo(95%CI: 10.6-17.0). Only alphafetoprotein(AFP) serum level > 200 ng/m L and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up(HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year(HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC(OR = 0.263, 95%CI: 0.111-0.622, P = 0.002).CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.
基金supported by ARC,Paris and Institut Hospitalo-Universitaire,Strasbourg(TheraHCC1.0and 2.0 IHUARC IHU201301187 and IHUARC2019 to TFB)the European Union(ERC-AdG-2014-671231-HEPCIR to TFB,EU H2020-667273-HEPCAR to TFB,and INTERREG-IV-Rhin Supérieur-FEDER-Hepato-Regio-Net 2012 to TFB)+5 种基金ANRS,Paris(2013/108 and ECTZ103701 to TFB)NIH(CA233794,CA209940,R21CA209940,and R03AI131066 to TFB)US Department of Defense(W81XWH-16-1-0363 to TFB)the Foundation of the University of Strasbourg(HEPKIN to TFB)and the Institut Universitaire de France(IUF,TFB)the framework of the LABEX ANR-10-LABX-0028_HEPSYSInserm Plan Cancer and benefits from funding from the state managed by the French National Research Agency as part of the Investments for the future program.
文摘Hepatitis C virus(HCV)infection is a major cause of liver disease and hepatocellular carcinoma worldwide(1).HCV is a blood-borne infection and prevalence is particularly high in patients with a history of injective drug use or unsafe health care or sexual practices.Substance use disorder(SUD),and especially opioid misuse is a growing problem worldwide(2).This is particularly relevant in the United States(US)where opioid misuse has raised sharply in the last years(3,4),termed also opioid epidemic.SUD is associated with an increase incidence of HCV infections and reinfections and associated liver disease(2,4).Moreover,alcohol use disorder is frequent in patients with SUD(5),representing another major risk factor for chronic liver disease in this population.Patients with SUD often experience poor access to health care resulting in higher mortality(5,6).Finally,SUD is associated with psychiatric conditions and social problems such as housing instability,unemployment,and reduced access to medical care(7)which could result in a reduced access and compliance to HCV treatment.
基金Inserm,the University of Strasbourg,the European Union(Infect-ERA hepBccc,ERC-2014-AdG-671231-HEPCIR and Horizon 2020 research and innovation programme under grant agreement 667273-HEPCAR)the Agence Nationale de Recherches sur le Sida et les Hépatites Virales(ANRS 15/1099)+3 种基金the French Cancer Agency(ARC IHU201301187)the US National Institutes of Health(NIH/NIAID U19AI123862-01,NIH/NIAID R03 AI131066,NIH/NCIR21 CA209940)This work has been published under the framework of the LabEx ANR-10-LAB-28 and benefits from a funding from the state managed by the French National Research Agency as part of the Investments for the Future(Investissements d’Avenir)programA.S.is the recipient of a fellowship co-funded by the Région Alsace,France,the LabEx HepSys and IHU Strasbourg.
文摘Liver cirrhosis and primary liver cancers are leading causes of mortality worldwide with over than 1.7 million of deaths in 2010 representing about 3.4%of the overall deaths(1).Global liver cirrhosis deaths ceaselessly increased by 52.2%from 1980 to 2010(1).Similarly,primary liver cancers global deaths increased by 62.4%from 1990 to 2010(2).
文摘Hepatitis C virus(HCV)is a main cause and important risk factor for hepatocellular carcinoma(HCC)in Western countries(1).Direct antiviral agents(DAAs)for HCV are highly effective and well-tolerated antiviral drugs which allow HCV cure even in patients with advanced liver disease.However,whilst HCV cure improves liver function and decreases overall HCC risk,a significant HCC risk persists in particular in patients with advanced fibrosis including cirrhosis who have the highest risk of developing HCC(2-4).
