AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France.
AP-HP, Hôpital Saint-Louis, SBIM, Université Paris Diderot, Inserm UMR 1153, Paris, France.
Hepatology. 2015 Sep;62(3):737-50. doi: 10.1002/hep.27743. Epub 2015 Mar 20.
Various critical events, liver related or not, occur in patients with compensated cirrhosis, but their respective burden remains to be prospectively assessed. The aim of this prospective cohort study involving 35 French centers was to capture the whole spectrum of complications occurring in compensated viral cirrhosis (VC) using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis resulting from hepatitis C virus (HCV) or hepatitis B virus (HBV); Child-Pugh A; and no previous hepatic complications. The cohort was considered as a multistate disease model, cumulative incidences (CumIs) of events were estimated in a competing risks framework. A total of 1,654 patients were enrolled from 2006 to 2012 (HCV, 1,308; HBV, 315; HCV-HBV, 31). During a median follow-up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4-year cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4-year cumI: 11.4% vs. 7.4%; P = 0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4-year cumI: 10.8% vs. 3.6%; P = 0.0004). Virological eradication/control was achieved in 34.1% of HCV and 88.6% of HBV patients and was associated with a marked decrease in HCC, decompensation, and bacterial infection incidences. Survival was shorter in HCV patients (4-year cumI: 91.6% vs. 97.2%; P = 0.0002). Death (n = 102; missing data: 6) was attributed to liver disease in 48 (47%; liver cancer: n = 18; miscellaneous, n = 30) and extrahepatic causes in 48 (47%; bacterial infection: n = 13; extrahepatic cancers: n = 10; cardiovascular events: n = 5; miscellaneous, n = 20).
After 3 years of follow-up, extrahepatic events still explained half of deaths in patients with compensated VC. A strong decrease in complications was linked to virological eradication/control.
本前瞻性队列研究涉及 35 个法国中心，旨在使用竞争风险分析来全面评估代偿性肝硬化患者发生的各种相关或不相关的肝脏相关并发症。
纳入标准为：组织学证实的由丙型肝炎病毒（HCV）或乙型肝炎病毒（HBV）引起的肝硬化；Child-Pugh A 级；无既往肝并发症。该队列被视为多状态疾病模型，使用竞争风险框架估计事件的累积发生率（CumIs）。2006 年至 2012 年共纳入 1654 例患者（HCV 1308 例，HBV 315 例，HCV-HBV 31 例）。中位随访 34 个月时，271 例患者至少发现 1 个肝结节，128 例（4 年 CumI：10.5%）被确诊为肝细胞癌（HCC），3 例为胆管癌。HCV 患者 HCC 发生率较高（4 年 CumI：11.4% vs. 7.4%；P = 0.05）。79.3%的 HCC 符合米兰标准，70.4%的 HCC 获得治愈性治疗。HCV 患者肝失代偿更常见（4 年 CumI：10.8% vs. 3.6%；P = 0.0004）。34.1%的 HCV 和 88.6%的 HBV 患者实现了病毒学清除/控制，HCC、肝失代偿和细菌感染的发生率显著下降。HCV 患者的生存率较低（4 年 CumI：91.6% vs. 97.2%；P = 0.0002）。102 例（缺失数据 6 例）患者死亡，48 例（47%；肝癌：18 例；其他：30 例）归因于肝脏疾病，48 例（47%；细菌感染：13 例；其他部位癌症：10 例；心血管事件：5 例；其他：20 例）归因于肝外原因。
随访 3 年后，代偿性 VC 患者的肝外事件仍占死亡原因的一半。并发症的大幅减少与病毒学清除/控制有关。
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