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Article Dans Une Revue Clinics and Research in Hepatology and Gastroenterology Année : 2021

Predictive Factors for Hepatocellular Carcinoma in Chronic Hepatitis B Using Structural Equation Modeling: A Prospective Cohort Study

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 CHU Saint-Antoine [AP-HP]
3 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
4 Hôpital Saint-Joseph [Marseille]
5 CHU Pitié-Salpêtrière [AP-HP]
6 Pathologies biliaires, fibrose et cancer du foie [CRSA]
7 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
8 IVH - Institut de Recherche sur les Maladies Virales et Hépatiques
9 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
10 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
11 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
12 Physiopathologie des Maladies Inflammatoires de l'Intestin
13 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
14 IAB - Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble)
15 U1162 - Génomique Fonctionnelle des Tumeurs Solides
16 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
17 NuMeCan - Nutrition, Métabolismes et Cancer
18 IMRB - Institut Mondor de Recherche Biomédicale
19 CHI Créteil
20 BaRITOn - Bordeaux Research In Translational Oncology [Bordeaux]
21 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
22 CHRO - Centre Hospitalier Régional d'Orléans
23 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
24 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
25 Irset - Institut de recherche en santé, environnement et travail
26 IPPRITT - Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation
27 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
28 PHARMA-DEV - Pharmacochimie et Biologie pour le Développement
29 CHU Rouen
30 Institut des Maladies de l'Appareil Digestif
31 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
32 CHU Nice - Centre Hospitalier Universitaire de Nice
33 C3M - Centre méditerranéen de médecine moléculaire
34 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
35 IP - Institut Pascal
36 CIC Nantes - Centre d’Investigation Clinique de Nantes
37 CHU Trousseau [Tours]
38 TIMONE - Hôpital de la Timone [CHU - APHM]
39 Immunité Innée - Innate Immunity
Tarik Asselah
  • Fonction : Auteur
  • PersonId : 1092822
Isabelle Rosa
  • Fonction : Auteur
Ghassan Riachi
  • Fonction : Auteur
Armand Abergel
Stanislas Pol

Résumé

BACKGROUND and AIMS: The factors predicting hepatocellular carcinoma (HCC) occurrence in chronic hepatitis B need to be precisely known to improve its detection. We identified pathways and individual predictive factors associated with HCC in the ANRS CO22 HEPATHER cohort. METHODS: The study analyzed HBV-infected patients recruited at 32 French expert hepatology centers from August 6, 2012, to December 31, 2015. We excluded patients with chronic HCV, HDV and a history of HCC, decompensated cirrhosis or liver transplantation. Structural equation models were developed to characterize the causal pathways leading to HCC occurrence. The association between clinical characteristics (age, gender, body-mass index, liver fibrosis, alcohol consumption, smoking status, diabetes, hypertension, dyslipidemia, alpha-fetoprotein, HBV DNA levels, antiviral therapy) and incident HCC was quantified. RESULTS: Among the 4,489 patients included, 33 patients reported incident HCC. The median follow-up was 45.2 months. Age (β = 0.18 by decade, 95% CI 0.14-0.23), male gender (β = 0.23, 95% CI 0.18-0.29), metabolic syndrome (β = 0.28, 95% CI 0.22-0.33), alcohol consumption (β = 0.09, 95% CI 0.05-0.14) and HBV DNA (β = 0.25, 95% CI 0.17-0.34) had a significant and direct effect on the occurrence of advanced liver fibrosis. Liver fibrosis (β = 0.71, 95% CI 0.55-0.87) predicted, in turn, the occurrence of HCC. CONCLUSIONS: Liver fibrosis mediates the effects of age, gender, alcohol, metabolic syndrome and HBV DNA on the occurrence of HCC. Elderly men with chronic hepatitis B, risky alcohol use, advanced liver fibrosis, metabolic syndrome and high HBV DNA levels should be monitored closely to detect the development of HCC.
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hal-03224103 , version 1 (15-06-2021)

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Laurent Lam, Hélène Fontaine, Marc Bourliere, Clovis Lusivika-Nzinga, Céline Dorival, et al.. Predictive Factors for Hepatocellular Carcinoma in Chronic Hepatitis B Using Structural Equation Modeling: A Prospective Cohort Study. Clinics and Research in Hepatology and Gastroenterology, 2021, 45 (5), pp.101713. ⟨10.1016/j.clinre.2021.101713⟩. ⟨hal-03224103⟩
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