Charlotte E Costentin1, Abbas Mourad2,3, Pierre Lahmek4, Xavier Causse5, Alexandre Pariente6, Hervé Hagège7, Anca Stela Dobrin8, Claire Becker9, Bérangère Marks10, Robert Bader11, Bertrand Condat12, Frédéric Héluwaert13, Jean François Seitz14, Bruno Lesgourgues15, Jacques Denis16, Sylvie Deuffic-Burban2,17, Isabelle Rosa7, Thomas Decaens18,19,20. 1. Hepatology Service, Henri Mondor Hospital, Public Hospital System of Paris, Créteil, France. 2. Lille Inflammation Research International Center (Unit 995, National Institute of Health and Medical Research), University Hospital Center of Lille, Lille University, Lille, France. 3. Science Faculty, Saint Joseph University, Beirut, Lebanon. 4. Addiction Service, Internal Medicine, Emile Roux Hospital, Public Hospital System of Paris, Limeil-Brévannes, France. 5. Hepatogastroenterology Service, La Source Regional Hospital, Orléans, France. 6. Hepatogastroenterology Service, Hospital Center of Pau, Pau, France. 7. Hepatogastroenterology Service, Intercommunal Hospital Center, Créteil, France. 8. Hepatogastroenterology Service, University Hospital Center of Besançon, Besançon, France. 9. Hepatogastroenterology Service, Hospital Center of Lens, Lens, France. 10. Hepatogastroenterology Service, Hospital Center of Valenciennes, Valenciennes, France. 11. Hepatogastroenterology Service, Hospital Center of Mulhouse, Mulhouse, France. 12. Hepatogastroenterology Service, St. Camille Hospital, Bry sur Marne, France. 13. Hepatogastroenterology Service, Hospital Center of Annecy Genevois, Pringy, France. 14. Hepatogastroenterology Service, University Hospital Center of La Timone, Aix-Marseille University, Marseille, France. 15. Hepatogastroenterology Service, Hospital Center of Montfermeil, Montfermeil, France. 16. Hepatogastroenterology Service, Hospital Center of South Francilien, Corbeil Essonnes, France. 17. Infection, Antimicrobials, Modeling, and Evolution (Joint Research Unit 1137, National Institute of Health and Medical Research), Paris Diderot University, Paris, France. 18. University of Grenoble, Grenoble, France. 19. Hepatogastroenterology Service, DIGI-DUNE Pole, University Hospital Center of Grenoble, Grenoble, France. 20. Institute for Advanced Biosciences (Unit 1209, National Institute of Health and Medical Research), Grenoble, France.
Abstract
BACKGROUND: Recent data suggest that alcohol-related hepatocellular carcinoma (HCC) is diagnosed at a later stage. The aim of this study was to compare HCC characteristics and outcomes in an alcohol-related group (group A) and a non-alcohol-related group (group NA). METHODS: A total of 1207 patients with newly diagnosed HCC were prospectively included between May 2008 and October 2009. Patients with multiple causes (alcohol plus another cause) were excluded. Patients were followed every year for 5 years. Recorded variables, including etiologies were tested as prognostic factors of survival in a multivariate Cox model after adjustments for a lead-time bias. RESULTS: In all, 894 patients were analyzed: 582 (65.1%) were in group A, and 312 (34.9%) were in group NA. Alcohol-related HCC was more likely to be diffuse and detected in patients with a worse performance status and worse liver function. After adjustments for a lead-time bias, the median overall survival (OS) was 9.7 and 5.7 months in groups NA and A, respectively (P = .0002), and 5.8 and 5.0 months in alcohol-abstinent and alcohol non-abstinent groups, respectively (P = .09). The prognostic role of alcohol disappeared when survival was assessed at each Barcelona Clinic Liver Cancer (BCLC) stage. Patients with HCC detected during a cirrhosis follow-up program (n = 199 [22.3% of the whole cohort]) had increased lead time-adjusted median OS in comparison with patients with HCC diagnosed incidentally (11.7 vs 5.4 months; P < .0001). CONCLUSIONS: In comparison with patients with non-alcohol-related HCC, patients with alcohol-related HCC have reduced OS, mainly because of worse liver function and tumor characteristics at diagnosis, as attested by similar survival within each BCLC stage. Cancer 2018;124:1964-72.
BACKGROUND: Recent data suggest that alcohol-related hepatocellular carcinoma (HCC) is diagnosed at a later stage. The aim of this study was to compare HCC characteristics and outcomes in an alcohol-related group (group A) and a non-alcohol-related group (group NA). METHODS: A total of 1207 patients with newly diagnosed HCC were prospectively included between May 2008 and October 2009. Patients with multiple causes (alcohol plus another cause) were excluded. Patients were followed every year for 5 years. Recorded variables, including etiologies were tested as prognostic factors of survival in a multivariate Cox model after adjustments for a lead-time bias. RESULTS: In all, 894 patients were analyzed: 582 (65.1%) were in group A, and 312 (34.9%) were in group NA. Alcohol-related HCC was more likely to be diffuse and detected in patients with a worse performance status and worse liver function. After adjustments for a lead-time bias, the median overall survival (OS) was 9.7 and 5.7 months in groups NA and A, respectively (P = .0002), and 5.8 and 5.0 months in alcohol-abstinent and alcohol non-abstinent groups, respectively (P = .09). The prognostic role of alcohol disappeared when survival was assessed at each Barcelona Clinic Liver Cancer (BCLC) stage. Patients with HCC detected during a cirrhosis follow-up program (n = 199 [22.3% of the whole cohort]) had increased lead time-adjusted median OS in comparison with patients with HCC diagnosed incidentally (11.7 vs 5.4 months; P < .0001). CONCLUSIONS: In comparison with patients with non-alcohol-related HCC, patients with alcohol-related HCC have reduced OS, mainly because of worse liver function and tumor characteristics at diagnosis, as attested by similar survival within each BCLC stage. Cancer 2018;124:1964-72.
Authors: Alex M Trafford; Rosa Parisi; Martin K Rutter; Evangelos Kontopantelis; Christopher E M Griffiths; Darren M Ashcroft Journal: PLoS One Date: 2021-07-19 Impact factor: 3.240